Drug Legalization and Harm Reduction

Drug policy:   A Tale of Two Countries

Australia and Sweden have taken different paths in the battle against illicit drugs.
Dr Lucy Sullivan examines the results.

A comparison of drug policies in Sweden and Australia. and of drug usage and associated problems, is highly suggestive of which country has chosen the more effective approach.

Sweden:

After beginning with a legal approach to illicit drugs, Sweden executed a volteface in response to escalating drug use in the population. Policy now aims at a drug-free society.

Coercive care of adult drug abusers was introduced in 1982: Swedish courts can order treatment instead of punishment if the offence carries no more than one year of imprisonment.

Drug use was criminalized in 1988, and a maximum penalty of six months’ imprisonment for illicit drug use was introduced in 1993, Possession of small quantities of cannabis or amphetamines may result in only a fine, but possession of heroin or cocaine receives a strict term of imprisonment. Drug trafficking maybe punished by 20 years imprisonment. Methadone assisted rehabilitation of drug addicts has been implemented.

Schools and municipal social services provide extensive education against drug use. Harm minimization, as a policy approach, and needle exchange have not been adopted, on the grounds that they would convey an ambiguous message against society’s attitude to drug abuse.

Australia:

In Australia generally, the maximum penalty for possession of small amounts of cannabis is two years imprisonment. In South Australia and the Australian Capital Territory, however, possession of small amounts of cannabis has been decriminalized. Trafficking in illegal drugs may be punished with life imprisonment.

Despite the legal position, Australia’s National Drug Strategy since the late 1980s has been one of 'harm minimization’, rather than prevention or a drug-free society. Through the late ‘80s and most of the ‘90s, there has been a movement in the allocation of funding, from law enforcement to education.

As an educational policy, harm minimization is defined as teaching safe use of drugs, abstinence is not seriously addressed.  Other features of Australia’s harm minimization policy are an extensive free needle exchange programme and free methadone maintenance for heroin addicts.
 

 

Sweden

Australia

Lifetime prevalence of drug use in 
16-29 year olds (Sweden) and 14-25 year olds (Australia) 

9%

52%

Use in the previous year, as above

2%

33%

Estimated dependent heroin users per million population

500

5-6000

Percentage of dependent users aged under 20

1.5%

8.2%

Methadone patients per million population

50

940

Drug-related deaths per million population

23

48

Percentage of all deaths at age under 25

1.5%

3.7%

 

 

 

Drug offences per million population -
Sweden = arrests; Australia = convictions

3100

1000

Average months in prison per drug offence

20

5

Property crimes per million population

51,000

57,000

Cumulative AIDS cases per million population

150

330

Outcomes:

The accompanying table shows comparative figures on drug abuse and related factors for Sweden and Australia as presented in the United Nations World Drug Report 1997 (adjusted where necessary to a rate basis).

The comparative figures for drug use in Sweden and Australia, taken in conjunction with education policies which promote abstinence versus safe usage, suggest that Australia’s policy of harm minimization has induced widespread drug usage - 52% lifetime usage (i.e., used at least once) in Australia compared with 9% in Sweden.

Further data indicate that the change from the liberal to prohibitive in Swedish policy has been effective in reducing the initiation of young users, whereas usage by young people in Australia has been rising over the same period.

The highest prevalence of lifetime usage in Sweden occurs in the 30-49 years age group. In Australia, the rates of usage are minimal above age 40, while the greatest increase in use has occurred in the 14-24 years age group. This demonstrates the success of education in harm minimization in encouraging drug use, particularly in the age group most exposed to drug education - school children.

Only 1.5% of Swedish young people (aged under 20) are drug dependent, compared with 8.2% of Australians in the same age group.

The information conveyed in harm minimization education is clearly unable to counteract the effect of higher usage rates. Drug-related death rates are twice as high in Australia as in Sweden - 46 versus 23 per million population. Moreover, the share of under 25 year-olds in drug-related deaths in Sweden is very low - only 3.6%. The Australian figure in this category was not available, but the percentage of all deaths at age under 25 (3.7% compared with 1.5% in Sweden) indicates a higher presence of trauma for Australian young people, of which drug  taking is likely to form a part. Free needle distribution in Australia does not appear to have resulted in better control of the AIDS epidemic here, with our cumulative AIDS rate more than twice that of Sweden. While the proportion of methadone patients to heroin addicts is similar in the two countries, one may conjecture that the use of methadone for rehabilitation in Sweden, rather than for maintenance as in Australia, contributes to the dramatically lower rate of heroin addiction there (less by a factor of at least 10).

The higher rate of illegal drug use in Australia is the more remarkable in that Australians are roughly as law-abiding as Swedes in relation to property crime, and far less violent. The lower ratio of convictions to usage rates in Australia may well encourage contempt of the law.

The proponents of the harm minimization strategy in Australia claim that Australia is leading the world in the public health of drug abuse.

These figures suggest, rather, that it is leading us in the opposite direction, and that a policy like Sweden’s, which addresses its goals straightforwardly and unambiguously, rather than deviously, is more successful in practice.

News Weekly,  August 28 1999  Page 8