Harm minimization or abstinence: an evaluation of current policies and practices in the treatment and control of intravenous drug using groups in Australia

Abstract

The past decade has seen Australia cited as a significant leader in the development of harm-minimization policies towards illicit drug use. Such policies have been developed on the premise that harm minimization would lead to substantial long-term gains to society in the areas of: (1) decreased health costs for intravenous drug users (IDU); (2) decreased mortality rates for IDU groups; (3) increases in social productivity of IDU (through such things as gaining and retaining employment); and (4) decreased criminal activity leading to substantial gains in law enforcement budgets, and reduced community crime costs (theft and burglaries, etc.) Evaluation of the success of harm minimization is notoriously difficult. By its nature success often means there are no ways of comparing potential losses against potential gains. An alternative to harm minimization, abstinence models, exist. In Australia the harm minimization policy has come under review in some States, and has never been fully implemented in the Northern Territory. This paper reviews the merits and demerits of both approaches, and initiates discussion regarding the development of future services for IDU groups in Australian society.