Captured by the ‘Just Say No’ approach, the federal government has long advocated an explicit stance on recreational drug use. Yet by unrealistically imploring young people to resist a growing social norm, authorities oversimplify a complex issue and fail to connect with drug users. Prohibition isn’t working. It is time to proactively analyse international evidence, encourage honest discussion, and debate alternatives to existing legislation.

A young male sits in a tent at a music festival, ganja in one hand, MDMA in the other. Armed with sniffer dogs and the mandate to enforce a zero-tolerance drug policy, police walk through an open flap into the tent. Now, the legal repercussions for this drug user, if at all, depend on where in the world this scenario has taken place.

Unlike some European nations that adopt decriminalisation and harm minimisation practices, Australia emphasises punitive drug legislation as the cornerstone of its ‘War on Drugs’, a phrase notably popularised by US President Richard Nixon. At a federal level, the Australian Customs Act aims to prevent the import of banned substances, and in Victoria, the Drugs, Poisons and Controlled Substances Act covers drug offences including use, possession, cultivation, trafficking (manufacture and sale), and driving under the influence of an illicit substance. The user above would be subject to this legislation, and could face a criminal record, fine, and/or imprisonment.

But instead of focusing on nuanced education based on evidence, current policy is aptly summarised by Greg Barns, a criminal law spokesperson for the Australian Lawyers Alliance, as an ‘irrational obsession with prohibition’ founded on ‘ineffective, “drugs are evil” type propaganda’. Prohibition may seem like a logical solution in theory; however, as demonstrated by the introduction of the Volstead Act in the 1920s (prohibition of the manufacture and sale of alcohol in the USA), drug prohibition is counterproductive and does not achieve the intended aims of reducing usage. The disruption to alcohol distribution serves as a model for understanding what happens when the demand for a drug remains strong after legal supply has been cut: the problem is driven underground as organised criminal networks profit.

Moreover, the bulk of drug-related hospital presentations result from adverse reactions to impure substances or drug overdoses. Prohibition means a lack of regulation of the recreational drug market, with no enforcement of manufacturing standards, no inspection of laboratories, and no assessment of the purity of substances. Substance adulteration and the entrance of dangerous research chemicals on to the drug scene are ubiquitous, with contaminated drugs moving from the pockets of dealers to the hands of unsuspecting consumers. There is zero accountability. The lack of repercussions allows dealers to claim products are one thing when they are really another, and as one user described in the documentary ‘What’s in My Baggie’: ‘you [consumers] are taking something on a pure basis of trust, that could kill you.’

Drug messages have also been ineffectively conveyed. Take the idealistic slogan, ‘Say No to Drugs’. It follows an old adage that telling someone not to do something invites rebellion and enhances curiosity, with such an approach being as naïve as ‘abstinence only’ approaches to sex education. Krystle Cole, founder of drug education site Neurosoup.com, argues that sensationalist analogies e.g. comparing the brain to an egg and ‘getting high’ to frying the egg, and inaccurately painting the harms of all drugs with the same broad brushstroke, leads some users to believe that ‘everything you’ve been taught was a lie and propaganda’ and to thus experiment more and really push the boundaries of drug use. Furthermore, the government’s advertising strategy to depict belligerent ice addicts indirectly stereotypes and misrepresents a diverse drug-taking community. It alienates recreational users of less damaging drugs such as cannabis and MDMA (‘pure ecstasy’), and makes social users immune to authoritarian warnings, which are arguably not applicable to them.

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So how else might have the initial scenario unfolded? What are the alternatives to the present hard-line model that demonises drug users?

Unregulated legalisation lies on one end of the spectrum, with drug-related behaviour neither dealt with as an offence by law nor restricted in society. Supporters of this very liberal proposal often object to drug laws on the grounds of autonomy, contending that individuals should have the freedom to make their own decisions and live with any associated consequences.

Perhaps more pertinent to this discussion are the next two schemes, the first of which is regulated legalisation. This model sees the establishment of a strictly controlled legal market for drugs, as is existing protocol with alcohol, tobacco, and pharmaceutical medicines. Crafted by Professor David Penington, an illustrated drugs expert and former Dean of Medicine at the University of Melbourne, the Penington Proposal adopts a similar model for the legal use of cannabis and ecstasy, roughly based on the following components:

Distribution of the two drugs by government-approved suppliers, most likely pharmacists, in tightly regulated quantities

Creation of a national, confidential user’s register

Financial feasibility, with a dispensing fee charged to consumers to cover drug production costs

Empowerment of pharmacists to educate consumers, and refer them to counselling or other medical services if deemed necessary

Continuation of adjunct harm reduction programs

Although some argue that the proposal may fail to compete with potentially cheaper drugs and the reduced stigma in purchasing drugs on the black market, Professor Penington’s recommendations are plausible, comprehensive and deserve serious thought. Finally, it is worth noting that proponents of the broader model of regulated legalisation do not necessarily condone drug use, but acknowledge the reality that some individuals will take drugs irrespective of overstated propaganda or legitimate health warnings, and for such users, those harms should be minimised.

The concept of harm minimisation segues into the third alternative: decriminalising the possession of small quantities of drugs for personal use. By reducing policing efforts and penalties for lesser drug-related offences, it is hoped that a shift in attitudes will see drug use addressed as a public health issue rather than a law enforcement one.

Critics of drug decriminalisation contend that the lack of quality control and sales regulation will continue to bolster the criminal underworld, and that removing penalties for possession may be the ‘tipping point’ for those who only considered drug use previously. On the flip side, this model redirects the sole attention of law enforcement towards larger criminal networks, as opposed to the current, pointless policing exercise of chasing individual users.

Returning to our festivalgoer, imagine that they had not just one ecstasy pill in hand, but their entire worth’s for the five-day festival when law enforcement were nearby. In moments of panic, it is not uncommon for users to overdose on their supply to avoid detection. Decriminalisation policy has unequivocal benefits here of reducing risk to users who would naturally fear prosecution.

The Netherlands, Portugal and Switzerland have all adopted decriminalisation-based policies, with promising results. According to the report of the second Australia21 Roundtable on Illicit Drugs, the Netherlands boast ‘declines in the number of drug-related problems including dependent opiate use, injection drug user-related HIV infections and drug-induced deaths’ since the introduction of de facto criminalisation of cannabis use via a coffee shop system. And whilst Portugal’s model of de jure decriminalisation of drug possession and use saw an initial spike in drug-taking behaviour, in the long term, rates dropped. According to the Home Office report, in 2007, the percentage of the population who had used cannabis in 2006 had increased from 3.25 to 3.6; heroin, 0.3 to 0.5; and cocaine, 0.25 to 0.6; however, from 2011 to 2012, cannabis rates decreased to 2.7%, heroin to <0.2%, and cocaine to 0.3%.

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Thus far we have analysed the failings of prohibition, alternative policies in theory, and also in practice around the world. So what role do we play as health professionals in this public health issue? I argue our focus lies in advocating for harm minimisation.

We must advocate for the accessibility of reagent testing kits at music festivals, to reduce the risk of hospitalisations and direct power away from dealers and back to consumers. Festivalgoers must be aware of the authenticity and purity of the drugs they are taking, as it is the ecstasy pill adulterated with unknown chemicals and additives that make the drug more dangerous than the actual psychoactive substance of MDMA itself.

We must advocate for honest education about drug use. And further, for users who will consume drugs irrespective of outside influences, we must offer advice regarding safe behaviours instead of taking the moral high ground, ignoring the issue, and later treating a patron who has overdosed. Our medical education has been grounded on the concept of preventative healthcare, from exercise and cardiovascular disease to sunscreen and skin cancer, so why should drug use be any different?

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Finally, we must lead discussion on alternatives to prohibition. Even beyond arguments about supply and demand, underground networks, and the role of law enforcement, the simple fact is that prohibition legislation is a barrier to those seeking healthcare. Prohibition disempowers families, who are less likely to seek support for kin in need of help, for fear of a criminal record and potential impact on their future employment. And what’s more, prohibition is a barrier to users seeking health advice or drug rehabilitation due to the fear of legal persecution, and the subsequent repercussions of criminal charges.

‘As much as we may deplore it, we must learn to live in a world where some young people use drugs. All drug use is not inherently evil. We would be better off keeping the focus on reducing the harm caused by drugs and drug policy.’

– Report of the second Australia21 Roundtable on Illicit Drugs