INCORRECT, INACCURATE and MISLEADING

The Australian government began studying the drug use of offenders in 1999, well after the World Drug Report of 1997 was published. The 2001 World Drug Report mentions no such figure, and since an IDEAS ad highlighting Australia claims to use data from the 1997 report, it can be presumed that the figure above comes from the 1997 report, and is anecdotal rather than based on evidence. As noted in the Australian Institute of Criminology's publication "Patterns of Drug Use Amongst Police Detainees: 1999-2000" by Toni Makkai et al., Dec. 2000:

"Drug Use Monitoring in Australia (DUMA) is the only project in Australia that is routinely monitoring the use of illicit drugs by people detained by police. Although there are many anecdotal stories about the use of drugs by detainees, this is the first authoritative research to both document and monitor use amongst this important group in the community. The collection began in January 1999 and the results presented here describe the extent of illicit drug use every three months in four sites across Australia. These data are comparable with international collections in a number of countries, including the United States and England. Until now, such cross-cultural comparisons have not been possible." (p. 1)

It is true that in Australia, as in many other countries, drug use among detainees is rather high. The DUMA report shows: "Detainees are most likely to test positive to cannabis (see Figure 1). This is consistent with the National Drug Strategy Household Survey data which showed that cannabis was the most commonly used illicit drug in the general community in 1998. Across the general population, around 39 per cent self-reported they have tried cannabis and 18 per cent reported using it in the past 12 months. Amongst this sample of detainees, the average number testing positive to cannabis use in the past 30 days was 63 per cent in Southport, 61 per cent in East Perth, 52 per cent in Parramatta and 47 per cent in Bankstown." (p. 3)

Arrestees in the US also show high rates of drug use -- much higher rates than in Australia. According to the US Justice Department in its 1999 Annual Report of the Arrestee Drug Abuse Monitoring program (National Institute of Justice, June 2000), "In 27 of the 34 sites, more than 60 percent of the adult male arrestees tested positive for the presence of at least one of the NIDA-5* drugs, ranging from 50 percent in San Antonio to 77 percent in Atlanta. For female adult arrestees, the median rate for use of any drug was 67 percent in 1999 compared to 64 percent in 1998. In 22 of the 32 sites, more than 60 percent of the adult female arrestees tested positive for at least one drug, ranging from 22 percent in Laredo to 81 percent in New York City. The median rate for use of any drug among male adult arrestees for both 1998 and 1999 was 64 percent." (p. 1)
(*note: "'NIDA-5' refers to the following five drugs: cocaine, marijuana, methamphetamine, opiates, and PCP.")

Australia does tend to have higher rates of *reported* drug use, because Australians have a high level of trust in their government and a long tradition of social research. According to the UN's World Drug Report 2000, published in early 2001, "Such high figures do point to high levels of consumption; but they may also have to do with the specific social and legal context in which studies take place. This results in the case of Australia (and some other countries with a long tradition of social research) in more readiness to admit to drug use, and thus far less under-reporting than in countries where drug users fear that such information could be used against them." (p. 74)

Australia performs an annual survey of drug use. The most recent, "Statistics on drug use in Australia 2000," published in May 2001, reports that:

"Nearly half of all Australians aged 14 years and over have used illicit substances at least once in their life, while 23% report having used an illicit drug in the preceding 12 months (Table 4.1). The most widely used illicit substance in Australia in 1998 was marijuana, with lifetime use of 39% and recent use of 18%. The prevalence of lifetime use of pain-killers/analgesics (for non-medical purposes) was 12%, followed by hallucinogens (10%) and amphetamines (9%). Only 2% of the Australian population had ever used heroin, with 1% reporting recent usage. The prevalence of cocaine use was slightly higher, with lifetime use in 4% of the respondents and recent use in 1%. The mean age of initiation for marijuana was 18.8 years, which was only slightly higher than the age of initiation for inhalants (17.5 years) and hallucinogens (18.4 years). The highest age of initiation was for tranquillisers/sleeping pills for non-medical purposes at 23.3 years, followed by ecstasy/designer drugs at 22.5 years and cocaine at 22.2 years." (p. 17)

Comparison: US drug use in general is very high. According to the US Centers for Disease Control, among high school students in the US (grades 9-12), 47.2% have tried marijuana, and 26.7% are current users. A total of 50% are current alcohol users, with 31.5% engaging in "episodic heavy drinking." (source: Youth Risk Behavior Survey, reported in Morbidity and Mortality Weekly Report, June 9, 2000, Vol. 49, No. SS-5, p. 60, Table 20). Another federal measure of drug use, the National Household Survey, reports that in 2000, among persons 18-25, 51.2% admit to having used an illicit drug in their lifetime, with 27.9% admitting to being a current user.

A UN report issued in mid-2001, "Global Illicit Drug Trends 2001," reports on the number of users of illicit drugs in the prison populations of several nations. According to this report in Australia in 1998, 50% of prisoners were illicit drug users (though there is no indication of whether the drug use was a contributing factor or merely incidental). The report indicates that in the US in 1994, 70% of the prison population were illicit drug users. The number of US prisoners who were using either alcohol or other drugs at the time of their arrest may be even higher now, according to the US Dept. of Justice's "Substance Abuse and Treatment, State and Federal Prisoners, 1997" (Bureau of Justice Statistics, Jan. 1999):

"In the 1997 Survey of Inmates in State and Federal Correctional Facilities, over 570,000 of the Nationís prisoners (51%) reported the use of alcohol or drugs while committing their offense. While only a fifth of State prisoners were drug offenders, 83% reported past drug use and 57% were using drugs in the month before their offense, compared to 79% and 50%, respectively, in 1991. Also, 37% of State prisoners were drinking at the time of their offense, up from 32% in 1991. Among Federal prisoners the reports of substance abuse increased more sharply. Although the proportion of Federal prisoners held for drug offenses rose from 58% in 1991 to 63% in 1997, the percentage of all Federal inmates who reported using drugs in the month before the offense rose more dramatically from 32% to 45%. A fifth of Federal prisoners reported drinking at the time of their offense in 1997, up from a tenth in 1991." (p. 1)

TRUE yet MISLEADING and INCOMPLETE

In Hong Kong, after 24 years of government-sponsored methadone treatment programs, only 200 of over 10,000 heroin addicts have been successfully treated. (South China Morning Post)

INACCURATE AND INCOMPLETE

According to the report in question:
"52. In the past five years, the number of registered methadone patients as at the end of each year maintained at about 9,000-11,000. Almost all of them received maintenance instead of detoxification treatment." (p. 9)

The programs themselves have a high dropout rate, and a low attendance rate:
"53. Patients who fail to attend the programme for twenty-eight consecutive days are considered as drop out. If they choose to join the programme again, they have to undergo the readmission process. In each of the past five years, about 9,000 drug addicts dropped out and over 80% of the registered patients were readmitted drug addicts, indicating large mobility of patients. (Appendix 5) 54. Each registered patient is allowed to receive methadone treatment once per day. The average daily attendance had decreased from 8,035 in 1991 to 6,401 in 1994. However, such figure bounced back to 7,002 in 1995, representing 71% of the average effective registered patients in that year. (Appendix 5)" (p. 9)

The programs are cost-effective in a sense, but since they are intended for maintenance, the report notes, they have a low graduation rate:
"60. Since there is no information on the duration of a methadone patient staying in the programme, it is difficult to estimate the total cost spent on each methadone patient in order to keep them away from drugs. As the average attendance is about 70%, the cost to maintain each patient in the programme is estimated to be HK$4,000 per year. As methadone programme in Hong Kong is chiefly for maintenance purpose, the number of patients successfully detoxified since the introduction of the programme was only 227." (p. 10)

Overall, the report was quite critical of HK's methadone maintenance program:
"72. According to the information provided by the Narcotics Division, only 227 methadone patients had been successfully detoxified since the implementation of the programme. A one-day survey conducted in July 1995 by the Department of Health also indicates that almost 50% of methadone patients had stayed in the programme for more than fifteen years. While it is noted that the present programme is basically for maintenance instead of detoxification purpose, the large number of drop-out cases and readmissions suggests that the patients are not maintained in the programme in a stable manner." (p. 13)

"74. The present methadone treatment programme cannot help drug addicts to achieve a drug-free state. It is also not known to what extent opiate dependence is reduced through participation in this programme. To evaluate the effectiveness of the programme in this respect, results of the urine tests taken on methadone patients by the Department of Health would be extremely useful. It is regrettable that such data are not published nor provided to the researcher." (p. 14)

On the other hand, the report notes there are pragmatic reasons why HK's methadone program can be seen as useful and effective: "75. It can be noted from the analysis in paragraphs 64-74 that methadone treatment programme is not particularly helpful to drug addicts themselves in improving their employment status, reducing the use of needles and abstaining from drugs. However, as there is a strong correlation between the price of heroin and programme attendance, there appears to be a need for the availability of an easily accessible means of substitute in case of an upsurge in heroin price.

76. As the unemployment rate among drug abusers is high, and over $200 on drugs per day is spent by each drug addict, some addicts may be driven to committing crime if methadone is not available. There will be a marked deterioration in the crime situation even if a small proportion of methadone patients engage in crime, as indicated by the comparison of the number of quick-cash crime and registered methadone patients below." (p. 14)

The report also notes that other countries have had better results with their methadone programs. For example, the US:
"79. Research conducted on the US programmes indicates that the effectiveness of methadone treatment varies greatly with the dose prescribed and the competence of the counselling services. It is found that the longer the patients remain in treatment, the lower the use of heroin, HIV seroprevalence and criminal behaviour. There is also marked improvement in the general health and nutritional status of the patients. Since criminality and risk of HIV/AIDS exposure has reduced, methadone treatment effectively reduces economic and social burdens." (p. 15)

and Australia:
"80. In Australia, it is estimated that 30,000-50,000 individuals regularly and 60,000 individuals occasionally abuse heroin. The number of methadone patients was about 1,000 in the early 1980s, but had increased to over 7,000 in 1990. The increase is due to the fact that methadone is now perceived as an effective intervention to prevent the spread of HIV infection among drug abusers. As a result, there has been a remarkable increase in methadone maintenance services and additional funding has been allocated to improve staff training for methadone programmes. Although methadone is the main drug approved for the management of heroin dependence, on occasions, other drugs such as codeine, dextramoramide, buprenorphine or oxycodone may also be prescribed." (p. 15)

MORE CURRENT INFORMATION

Again, this report and the negative press occurred in 1996. Contrast this attitude with a recent report in the South China Morning Post on November 17, 2001: "Landmark experiment a sign authorities are willing to tackle growing mainland epidemic," abstract from scmp.com: "China is to launch its first project using methadone to help drug-users beat their addictions, state media reported yesterday, in a further sign the mainland is taking its Aids crisis more seriously."

A report in the South China Morning Post from July 24, 2000, indicates that buprenorphine may replace methadone as a preferred treatment (on the web at http://www.mapinc.org/drugnews/v00/n1042/a04.html, "Study Finds Near Perfect Drug Addiction Remedy"). Note particularly that the success rate for methadone treatment in Hong Kong is given here as 70%, though with a caveat. "A medicine used as a painkiller has a near total success rate in helping heroin addicts quit and could become a replacement for methadone, researchers have reported.

Dr Dominic Lee Tak-shing, an associate professor at the Chinese University's department of psychiatry, co-ordinated the study, which found that buprenorphine worked on 109 out of 110 addicts. The trial involved patients at the new Caritas Wong Yiu Nam Drug Abusers' Rehabilitation Centre, which opened in April. The success rate of methadone treatment in Hong Kong is about 70 per cent, but the figures do not take into account those who relapse over a period of time after treatment. Dr Lee said the subjects were free of addiction after three days of treatment, which costs $100 per patient, and showed milder degrees of withdrawal symptoms such as vomiting, pain in the bones and tiredness. The methadone treatment takes three weeks."

Another article in the South China Morning Post, from June 20, 2000,"Amnesty for Addicts to Register," available at: http://www.mapinc.org/drugnews/v00/n842/a10.html notes that China now admits that it has a huge and growing drug use problem: "China's chief anti-drug official reported in March that China had 681,000 drug addicts last year, a 14 per cent increase over the previous year."

ADDITIONAL INFORMATION

Methadone programs have been found to be effective measures both for reducing the harm from opiate use as well as for helping people stop using opiates. The American Journal of Public Health reported in May 2001 (Langendam, Miranda W., PhD, et al., "The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users," American Journal of Public Health, Vol. 91, No. 5) that:

"Our results support the hypothesis that harm-reduction-based methadone maintenance treatment decreases the risk of natural-cause and overdose mortality. Furthermore, our data suggest that in harm-reduction-based methadone programs, being in methadone treatment is important in itself, independent of the pharmacologic effect of methadone dosage. To decrease mortality among drug users, prevention measures should be expanded for those who dropout of treatment." (p. 779)

The Journal of the American Medical Association reported the NIH Consensus Statement on opiate addiction treatment in December 1998 ("Effective Opiate Addiction Treatment - NIH Consensus Conference," Journal of the American Medical Association, Vol. 280, No. 22, Dec. 9, 1998, pp. 1936-1943), which calls for expansion of methadone services. According to it:

"Conclusions.-Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it. All persons dependent on opiates should have access to methadone hydrochloride maintenance therapy under legal supervision, and the US Office of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation. There is a need for improved training for physicians and other health care professionals. Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance programs." (p. 1936)

FALSE