More Australians die from overdose than on our roads, but criminalisation is not the answer

By Kathryn Daley

Criminalisation has not solved Australia’s so-called ‘drug problem’ - in fact, fatal overdoses are at a 10-year high. In this piece, Kathryn Daley explains why regulation and harm minimisation are the right way forward.

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Photo by Charles Chen on Unsplash

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Content warning: This article contains details of drug use, addiction, overdose, and death.

My brother died of an accidental overdose when he was 27. His death was 18 years ago, and a lot has changed in the world since then, but no one has solved the ‘drug problem’. In fact, Victoria’s annual overdose deaths are currently at a 10-year high. More than 2,000 Australians die from overdose every single year - a figure exceeding the annual road toll.

But drug use is not the cause of drug problems. Most people who use drugs do not ever have a drug problem, and most people with a drug problem are not using drugs for fun.

Substance abuse is anaesthetic for emotional pain. People cannot simply ‘stop taking drugs’ – sometimes that anaesthetic is the only thing making life bearable. Recovery is slow and requires a lot of material, social, physical and emotional support. During this time, a harm reduction approach to substance use is necessary: harm reduction saves lives, yet harm reduction measures are unnecessarily controversial.

Since 1985, Australia’s drug policy has formally adopted a Harm Minimisation strategy. It is a three-pronged approach of demand, supply and harm reduction. Harm reduction is the part that accepts that no matter how much we invest in supply and demand suppression, some people will still use alcohol and other drugs. Accepting this, and from a public health lens, it is best to reduce the harms associated with it.

Harm reduction measures include needle and syringe programs, supervised injecting facilities, the free availability of the opioid-reversal drug Naloxone, and state-funded treatment services that do not mandate abstinence as the only measure of success. The regulated sale of alcohol is also an example of harm reduction.

Recently, the Victorian government announced the next step in harm reduction: the introduction of a fixed-site for drug checking (colloquially referred to as pill testing, but they can test most drugs, not just pills). It’s a progressive move for the Allan government who previously reversed the Andrews’ government commitment to open a supervised injecting facility in Melbourne’ CBD. And importantly, it is an evidence-based public health measure. Queensland have recently banned drug checking despite positive outcomes from its program – a decision that was political rather than evidence-based.

The night my brother died, on the phone to 000, waiting what seemed an eternity for an ambulance, I kept repeating, ‘they need to bring Narcan’. I tried in vain to give CPR to my beautiful brother, his bedroom floor askew with a spilt bottle of Xanax and a used syringe.

At the time, almost every fatal overdose was the combination of these two drugs: a benzodiazepine and heroin. There became so many of these deaths that the Victorian Coroner became vocal about them being preventable. It’s almost impossible to get Xanax anymore, whereas Jared had been prescribed a bottle of 100 pills.

These deaths drove successful advocacy for the take-home Naloxone program. Naloxone is Narcan—the drug I was desperately waiting on the ambulance for.

Sceptics will point out the obvious fact: overdoses only happen when people choose to use drugs. Which is true, of course. Like how heart disease prefers those with high cholesterol and lung cancer prefers smokers, and that melanoma is almost entirely preventable if people just stayed inside. But all people deserve health care, and that is what harm reduction is.

The ambulance arrived but Jared was already dead. My mother was frozen and time stopped. Around me, the house was filled with police, a crime scene photographer and a body bag. The detectives interviewed us. They seemed interested in finding out where the heroin came from. We didn’t care - it didn’t matter.

Turns out Jared had obtained the drugs in North Richmond – right where the supervised injecting facility now stands. It didn’t exist back then, but residents, councillors and shop owners were pleading for one to open to take the overdoses off the streets. It’s clear that memory fades fast, because there’s now calls to move the facility elsewhere.

The drug dealer was not responsible for my brother’s death, and neither was my brother’s psychiatrist. In today’s times, there is no way someone would be prescribed the dose and volume of Xanax that Jared had available to him that night. But the psychiatrist didn’t know he would use heroin, and the heroin dealer didn’t know he would use Xanax. But even if they did, it wouldn’t have changed anything.

Jared lived in pain. He had a tortured life, cursed by a profound intellect that left him unable to connect with the wider world. A late bipolar diagnosis made a lot of things make sense. The highs and lows of it were extreme. But it was the psychosis that terrified him. Drugs stopped all of that: the pain, the hallucinations, the depression – they made him stop feeling, and that served a very useful purpose for him.

His story is sad, though it isn’t unique. I am sharing it to try and convey why, even if we hate drugs, we must see harm reduction measures as essential public health measures. Having a drug available that reverses overdose and is impossible to abuse, saves the life of the person overdosing but also stops the witnesses, families and police officers from accumulating this trauma too.

There was a time when alcohol was illegal, and many people died from the bathtub gin available on the black market. Criminalising drugs makes them dangerous. Regulating them makes them safer. Enabling people to test their drugs, to make informed decisions about what they are taking and where they are taking it, prevent fatal overdoses. It is good public health policy.

Nobody grows up aspiring to be dependent on drugs, and everybody deserves health care.

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About the author

Kathryn Daley

Dr Kathryn Daley is the Assistant Associate Dean of Social Science Research and Policy at RMIT University. She is also the Chairperson of Youth Workers Australia and authored the book, Youth and Substance Abuse.