Heroin Harm Minimisation Part 1

heroInsight April/May 2000

A Crime and Justice Bulletin by Don Weatherburn and Bronwyn Lind

Summary by Evan Thomas

Drug law enforcement and treatment are often considered as alternative approaches to dealing with the problem of illicit drugs. Evidence is presented showing that drug law enforcement can encourage heroin users into treatment, thereby reducing some of the harm associated with heroin use. However, there is also evidence that drug law enforcement can have unintended consequences which increase other harms associated with heroin use.

Recent research suggests that, instead of debating whether to invest public money in drug law enforcement or treatment, policy makers should concentrate on determining the optimal mix of enforcement and treatment, and policies for minimising public health risks created by law enforcement.

The Effect of Law Enforcement on the Cost of Heroin

In theory, law enforcement can be used to impose a significant monetary cost on heroin use. This can be done through two mechanisms. Firstly supply-side drug law enforcement [ie directed at drug producers, importers, distributors etc.] can be used to make heroin scarce. This should make the price rise. Second, enforcement plus tough penalties create substantial risks for importers and distributors who consequently won't take the risk unless they make substantial profits. This too should act to keep the price of heroin high.

In practice supply-side enforcement does not seem to have restricted the availability of heroin. The drug is now readily available in all mainland states. Law enforcement efforts also appear to have failed. According to the Australian Bureau of Criminal Intelligence [1 999] the price of heroin has fallen and the purity increased.

US research suggests that 50% of the cost of cocaine can be attributed to risk compensation. Heroin in Cabramatta sells for $30-50 a cap [0.02g]. [If the pharmaceutical drug codeine (like heroin, an opioid substance] was sold in caps it would sell for just 40 cents a cap.] Heroin is very expensive relative to similar pharmaceutical drugs.

The non-monetary costs which drug law enforcement imposes on heroin use are obvious. They include the social stigma, inconvenience, fear and anxiety about being assaulted, arrested and imprisoned etc.

NSW research by Weatherburn, Lind, and Forsythe [1999] provides evidence that police `interaction' with users while shooting up is quite unpleasant for a number of reasons, for example, 71% of the users had been arrested for drug related crime. Purchasing heroin is regarded as fairly or very risky.

It is clear, then, that dependent heroin users encounter significant non-monetary costs both in use and in the pursuit of heroin from their suppliers.

Does Drug Law Enforcement Deter Heroin Use or Prompt Users to Seek Treatment?

Commonsense suggests that one effect of prohibition and drug law enforcement should be to deter drug use. The fact that less than one per cent of Australians are recent heroin users and less than three per cent have ever used heroin seems to support that assumption.

Appearances, however, can be deceiving. It is possible that other factors [eg. fear of disease etc.] may be partly responsible for low heroin use. After all, cannabis use is also prohibited, yet 18% of Australians are recent cannabis users.

The available evidence gives us little clue as to the deterrent effects of drug law enforcement. However, it would be a mistake to conclude, from the lack of evidence that drug law enforcement deters drug use, that no deterrent effect exists.

Weatherburn et al [1999] obtained evidence that drug law enforcement encourages some groups of users entry into treatment. In this study heroin users were asked to rate the importance of various reasons for seeking methadone treatment. 90% said that they wanted to spend less money on heroin, 63% wanted less involvement in crime, and 6 % wanted less trouble with police/courts.

Bammer and Weekes [1993] interviewed a number of heroin users and asked them what influenced their `final' decision to stop. Respondents cited progressive fatigue with a lifestyle made very unpleasant by the threat of imprisonment, poverty, guilt caused by stealing from friends, and the danger in obtaining heroin.

Weatherburn et al [1999] found evidence that law enforcement indirectly encourages entry into treatment through its effects on the monetary costs of heroin.

What is the benefit, in terms of harm reduction, of encouraging heroin users into methadone maintenance treatment [MMT]? Rigorously controlled trials have shown MMT reduces an individual's consumption of heroin and their involvement in crime [Hall 1996]. So by encouraging heroin users into MMT, law enforcement and the justice system could be said to limit the amount of crime committed to purchase it.

Far from being contradictory approaches to harm minimisation, then, coercion and treatment may in fact rely to some extent on each other for their beneficial effects. Without drug law enforcement fewer heroin users would enter or remain in treatment. Without treatment drug law enforcement would exert less effect on heroin consumption and drug-related crime.