1. What lessons should we draw from methamphetamine? Dr Alex Wodak AM, President Australian Drug Law Reform Foundation Tackling Methamphetamine Conference Sydney Boulevard Hotel alex.wodak@gmail.com 1

2. ‘Drivers: select your rut carefully – you’ll be in it for next 30 km’ 2

3. Topics: Must select most important questions: – How did we get here? – What is to be done? How has Australia responded to illicit drugs? Has Australia’s response worked? What are other countries doing? What should Australia do? What should Australia not do? Conclusions 3

4. How has Australia responded to illicit drugs? International movement started early 20 th C 3 UN treaties (1961, 1971, 1988) UN system established devise policy, implement, & monitor Almost all countries approved treaties, including Australia Countries approving required pass laws imposing criminal sanctions trafficked, used 4

5. How has Australia responded to illicit drugs? 2 Aims system: Prohibit recreational use certain drugs (≈ 250) Not interfere their medical, scientific use Australia’s 9 governments allocate 2/3 funding to drug law enforcement Politicians use harsh language for drug users 1985 adopted harm minimisation official national drug policy – ‘balanced’ approach 5

6. Australian governments spending illicit drugs 2009/10: Policy domain$ millionPercentage Prevention 157 9 Treatment 362 21 Harm reduction 36 2 Law enforcement 1123 66 Other 23 1 TOTAL1701 100 6

7. Has Australia’s response worked? ‘However beautiful the strategy, you should occasionally look at the results’ Winston Churchill Market Production  Consumption  Availability  Price  Purity  # Drug types  New drugs like ice 7

8. Has Australia’s response worked? 2 Outcomes Deaths  Disease  Crime  Corruption  Mass violence  Why has drug prohibition survived? 8

9. ‘Teach a man to fish and he can eat for a day Teach a man to sell drugs and he can pay for a Ferrari by Xmas’ 9

10. What are other countries doing? Also adopting harm reduction Extending harm reduction from drugs to drug policy Netherlands (1970s), Switzerland (1990s), Portugal (2001) – redefined drugs as primarily health & social problem Americas 2010s – 4 states USA tax & regulate cannabis, Uruguay, Geneva, Jamaica Crisis: UNGASS April 2016 New York 10

11. Australia, ice: ‘the war on drugs is … not a war we will ever finally win; the war on drugs is a war you can lose’ PM Tony Abbott 29.4.15 We cannot police, arrest, imprison our way out of the drug problem Ken Lay other senior police 11

12. What should Australia do: Threshold: redfine drugs as primarily health, social problem Invest drug treatment to improve capacity, quality, range, flexibility – Current funding only ½ needed – Need to raise quality other health services – Provide range options from minimal to maximal – Inflexible: hamstrung by law enforcement lens – Need to also prescribe to severely dependent, treatment refractory 12

13. Why some drug users matter more than others: 70% ice users consume < monthly Minority consume very heavily, account disproportionately for crime, probably also for recruiting novices So critical for future growth market Need effective way dealing severely dependent, Rx refractory: probably pharmacological Non agonist Rxs: many tried, all failed 13

14. Why some drug users matter more than others: Need a ‘methadone’ for stimulants But this research made very difficult Some research been done, need more Need better agents 14

15. What should Australia do: 2 Reduce emphasis criminal sanctions – raise thresholds, reduce penalties Increase regulated part of drug market Reduce inequality, reduce youth unemployment Increase harm reduction: distribute clean pipes, establish drug consumption rooms 15

16. What should Australia not do: Throw even more money at drug law enforcement Increase penalties Believe that ice advertisements will make any significant difference: mass campaigns small, temporary benefit, mainly political Sometimes make things worse Fantasise compulsory drug Rx a panacea Keeping sending wrong message: fear & hate 16

17. Conclusions: 20 th C global drug prohibition evolved, peaked, now declining Many leaders now say: ‘War On Drugs’ failed Encouraged more dangerous drugs to push out less dangerous drugs But though drug prohibition failed, like Viagra for politicians facing elections Bad policy = good politics High prevalence methamphetamine use, problems Australia compared other countries 17

18. Conclusions: 2 Redefine drugs as primarily a health and social issue: improve drug treatment Stop relying so heavily law enforcement, mass campaigns Increase regulated proportion drug market Increase drug treatment & focus helping minority severe dependence, Rx refractory 18