There is the risk of idiosyncratic and toxic reactions that, although rare compared with the frequency of drug use, can cause harm in some individuals. The sharing of needles, sadly still common among some injecting drug users, is associated with the transmission of blood-borne viruses such as HIV and hepatitis C. More recently the possibility of an association between chronic cannabis abuse and psychosis has been described, although this potential link requires further research. Finally, substance dependence can develop after frequent drug use (not after first time injection, as is sometimes assumed), which impacts negatively upon the lives of many people.

As a community we have a responsibility to implement measures that have been proven to reduce these harms and are based on the best available evidence. The harm reduction approach, which is a central tenet of Australia's response to illicit drug use, is just such a method. Harm reduction evolved in response to the rapid spread of HIV/AIOS among injecting drug users during the 1980s. It includes a range of strategies that aim to reduce harms to both injecting drug users and the wider community.

These harms include the social and economic costs of illicit drug use and HIV/AIDS, the legal costs associated with the justice system and the impact upon basic rights such as access to health care and social services. Harm reduction recognises that despite the risks associated with drug use and despite our best efforts, some people will not stop using drugs. Given this undeniable reality the primary objective of harm reduction is to reduce the harmful consequences of drug use, rather than focusing solely on reducing drug consumption and supply. The harm reduction approach includes a number of complementary strategies.

These include the provision of information and counselling to injecting drug users, the provision of drug treatment and drug substitution services, peer outreach programs and the provision, distribution and disposal of clean needles and syringes. More recently it has included access to safe injecting rooms and medically prescribed heroin to registered users. All of these approaches are supported by concrete evidence. Needle and syringe programs have been shown in a number of studies to decrease the transmission of HIV, hepatitis C and other blood- borne viruses.

The evidence is also clear that drug substitution treatment (such as methadone and buprenorphine) to heroin-dependent individuals reduces the risk of overdose and has beneficial impacts upon health, employment and general well-being. The evidence is also mounting that safe injecting rooms and heroin trials have produced positive outcomes for individuals and the broader community. The common retort that such measures `send the wrong message' or encourage drug use is simply not accurate. The published literature is clear and unambiguous on this point.

The introduction of harm reduction measures such as needle and syringe programs and safe injecting facilities is not associated with an increase in drug use. In the same way that we do not deny smokers access to treatment simply on the grounds that this would send the wrong message, we cannot and should not deny drug users access to interventions that save lives. Some governments have replaced criminal penalties for cannabis consumption with a system of civil penalties. Their critics argue that such changes send the wrong message. Again such arguments are unsupported by the facts. Evaluation of similar models has shown that the adoption of civil penalties for personal cannabis use is not associated with increased use of the drug.

Another popular perception among critics of harm reduction is that these initiatives are extremely unpopular among Australians. Again the facts Economics Research and Evaluation speak for themselves. Federal and state governments currently fund a number of harm reduction interventions (needle and syringe exchange, drug substitution etc.) throughout Australia and these have strong bipartisan support.