Prevent harm if we cannot prevent use<\/p>\n
By Chris W. Green<\/p>\n
JAKARTA (JP): \"This is a drug-free area.\" So shout the banners
\ndisplayed in many communities in Jakarta and around Indonesia.
\nParadoxically, banners like this are most prominent in the areas
\nwhere everyone knows that it isn't true, in places where drug use
\nhas already become an epidemic.<\/p>\n
There can be few who are not aware that drugs are an
\nincreasing threat to the future of the nation, although not many
\nare fully aware of the scale of the threat. Even less clear is
\nhow to respond to it. Other banners exhort us to \"Just Say No\" to
\ndrugs, even though many of us know how difficult it is to say no
\nto that most legal of drugs, tobacco.<\/p>\n
Of course, the easy answer is prohibition. Eliminate the
\nsupply of drugs.<\/p>\n
Would that it was that easy! Around the world, billions of
\ndollars are spent trying to reduce the supply of drugs, with
\nlittle or no impact on availability or price. Profits from supply
\nof illegal drugs far exceed what law enforcement authorities can
\nafford anywhere in the world, let alone in Indonesia. Here, these
\nprofits probably already exceed the combined budget of the police
\nand the armed forces. Huge sums of money are available for
\ntraffickers to bribe their way out of problems.<\/p>\n
Of course, we must try. But we must also be aware that our
\nefforts are almost certainly doomed to failure. And we must
\ntherefore find alternative strategies.<\/p>\n
The obvious choice is prevention. Encourage our children to
\nsay no to drugs. But this is also by no means easy, especially if
\nwe leave the problem to others. We cannot pass the responsibility
\nto teachers or preachers -- rarely do they know much about drugs,
\nand they spend only a very limited time with the children. In
\nfact, research now shows that school-based drug programs are more
\nlikely to increase drug use, and at best make little difference.<\/p>\n
Another mistake is to assume that our kids, being \"good\", will
\nnot be tempted. A combination of peer pressure and curiosity,
\nboth very prevalent among adolescents, will influence even the
\n\"best\" children.<\/p>\n
For prevention to be effective, it must start in the home, in
\nthe family, and start early -- by the time the children reach the
\nage of nine or ten they are already becoming aware of drugs and
\nbeginning to ask questions -- usually to their peers who know no
\nbetter than they do. Better they hear the right answers from us
\nbefore that occurs.<\/p>\n
Even the best parental guidance will have little impact upon
\nthose who are already addicted to drugs. Although patience and
\nencouragement are crucial, success in curing addiction must start
\nwith a real commitment by the addict. Without this, relapse after
\ntreatment is almost inevitable.<\/p>\n
Strangely to those of us who have never been under the
\ninfluence of drugs and who only see the harm which addicts do to
\nthemselves, few are ready to make such a commitment. With all its
\nproblems, the world of addiction they live in seems better than
\nreality -- and as we know, reality in Indonesia can be hard!<\/p>\n
Sadly, few addicts are really aware or concerned about the
\nharm they are doing to themselves. Few consider the threat of
\ndeath through overdose or from AIDS or other conditions. The risk
\nof these harms is greatest among drug users who inject. In
\nparticular, HIV, the virus which causes AIDS, is most efficiently
\nspread through the sharing of needles -- once the virus has
\ninfected one member of a group sharing needles, the
\nrest of the group can become infected within days. Experience
\naround the world has shown that once more than 10 percent of
\ninjecting drug users (IDUs) in any community become infected by
\nHIV, without extremely effective intervention that rate has
\nusually exceeded 50 percent within a year.<\/p>\n
There are signs that we are almost too late to prevent this
\nhappening in parts of Indonesia. Surveys have shown HIV rates
\nalready as high as 20 percent among IDUs in Jakarta. Extremely
\nurgent action is needed to address this. We are too late to
\nprevent these people using drugs; we cannot expect quick success
\nin attempting to stop most of them using drugs. What we must do
\nquickly is to reduce the harmful effects, including the spread of
\nHIV. Again, experience around the world has shown that there are
\nreally only two responses that are effective -- and these can be
\nvery effective, if controversial. The first is to try to
\nencourage IDUs to stop injecting, usually by providing
\nalternatives such as methadone, a cheap liquid drug that is taken
\norally. For those not ready to change to methadone, providing
\neasy, cheap access to clean needles is really the only solution.<\/p>\n
Neither of these approaches is ideal. But both work. Both will
\nhelp ensure that when users are finally ready to make the
\ncommitment to stop using drugs (as most do sooner or later), they
\nwill still be healthy and able to play a productive role in
\nsociety.<\/p>\n
As we consider our options and look for solutions on the
\nInternational Day against Drug Abuse and Illicit Trafficking on
\nJune 26, let us not ignore the large number of our young people
\nwho will not be reached by strident prevention messages. If these
\nare to survive, they need our support to avoid the harmful
\neffects of their drug use.<\/p>",
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"sponsor": "Okusi Associates",
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