Twenty three years ago, in an attempt to slow the spread of HIV among injecting drug users, my colleagues and I started Australia’s first needle syringe program. I had previously submitted 13 proposals for a pilot needle syringe program to the NSW Department of Health in the years leading up to this. All my proposals had been rejected. Our pilot needle syringe programs in inner-city Sydney in November 1986 breached the NSW Drugs Misuse and Trafficking Act (1985). Although I was interviewed at length by police, no charges were laid against me or my colleagues. Those were very difficult years for me. I was often vilified as I campaigned vigorously for the decision to introduce needle syringe programs to be speeded up.
Today a new study was released, Return on Investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia, commissioned by the Commonwealth Department of Health and Ageing. The study found that every dollar spent on needle and syringe programs saved the states and the Commonwealth four dollars.
The researchers estimated that about 30 million needles and syringes have been distributed every year in Australia since 2000. This has directly prevented more than 32,000 cases of HIV infection and almost 100,000 cases of hepatitis C. The prevention of these infections represents an estimated saving in healthcare costs of $1280 million.
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The report estimated that from 2000-2009, needle syringe programs in Australia cost a total of $243 million. If the costs and productivity gains and losses of injecting drug users are included, then the net present value of needle syringe programs is $5.85 billion. This means that for every one dollar invested in needle syringe programs between 2000-2009, $27 was returned. The return on this investment would have been even greater if longer time periods had been chosen.
This approach to drug problems is called “harm reduction”, which means that “the best is not allowed to become the enemy of the good”. That is, while waiting for a drug-free Australia to materialise, and for all crime and dishonesty to disappear permanently, let us at least make sure that we hand on our nation to the next generation with HIV under reasonable control.
The miracle was that the politicians of the day did us proud. Common sense, compassion and rationality briefly flourished in the land. Politicians put aside their differences and “short-termism” and made bold decisions for the long-term interest of the community. Police, government officials, gay men, sex workers, drug users, clinicians and researchers sat as committees and provided ministers with invaluable and sensible advice.
From 1999, the Howard government discretely provided the states and territories with $10 million per year to enhance their needle syringe programs while publicly vilifying harm reduction and those who advocated it.
My personal experience of trying to introduce needle syringe programs made me wonder why I had provoked such opprobrium. I began to read about the history of our drug policy and discovered that global drug prohibition developed from a meeting held in Shanghai in 1909 convened by the US government. American missionaries had been appalled at the way that the British had forced opium on to the Chinese people and the misery this had caused. The missionaries had pressured the US government to act. The British had initially started the trade in Indian opium in response to the huge positive trade balance China had been running with Britain and colonial India.
I began trying to read about the costs and benefits of drug prohibition. Information about financial and non-financial costs was easy to find but identifying benefits was, and still is, a real challenge. None of this is a surprise to pragmatic business people used to reading the bottom line of balance sheets. After the fall of the Berlin wall, we should all realise that there is always a huge price to be paid by trying to ignore powerful market forces.
No one can pretend that these are easy areas. My major regret about the introduction of needle syringe programs is that it took me until November 1986 to act. Twenty three years later the debate has turned to the now widely acknowledged failure and futility of drug prohibition. Let’s hope that our politicians today are prepared to act as boldly as the politicians of a previous generation. Again, the returns will be better than investing in the stock market.
Dr Alex Wodak is the president of the Australian Drug Law Reform Foundation