Prevent harm if we cannot prevent use

Prevent harm if we cannot prevent use

By Chris W. Green

JAKARTA (JP): "This is a drug-free area." So shout the banners
displayed in many communities in Jakarta and around Indonesia.
Paradoxically, banners like this are most prominent in the areas
where everyone knows that it isn't true, in places where drug use
has already become an epidemic.

There can be few who are not aware that drugs are an
increasing threat to the future of the nation, although not many
are fully aware of the scale of the threat. Even less clear is
how to respond to it. Other banners exhort us to "Just Say No" to
drugs, even though many of us know how difficult it is to say no
to that most legal of drugs, tobacco.

Of course, the easy answer is prohibition. Eliminate the
supply of drugs.

Would that it was that easy! Around the world, billions of
dollars are spent trying to reduce the supply of drugs, with
little or no impact on availability or price. Profits from supply
of illegal drugs far exceed what law enforcement authorities can
afford anywhere in the world, let alone in Indonesia. Here, these
profits probably already exceed the combined budget of the police
and the armed forces. Huge sums of money are available for
traffickers to bribe their way out of problems.

Of course, we must try. But we must also be aware that our
efforts are almost certainly doomed to failure. And we must
therefore find alternative strategies.

The obvious choice is prevention. Encourage our children to
say no to drugs. But this is also by no means easy, especially if
we leave the problem to others. We cannot pass the responsibility
to teachers or preachers -- rarely do they know much about drugs,
and they spend only a very limited time with the children. In
fact, research now shows that school-based drug programs are more
likely to increase drug use, and at best make little difference.

Another mistake is to assume that our kids, being "good", will
not be tempted. A combination of peer pressure and curiosity,
both very prevalent among adolescents, will influence even the
"best" children.

For prevention to be effective, it must start in the home, in
the family, and start early -- by the time the children reach the
age of nine or ten they are already becoming aware of drugs and
beginning to ask questions -- usually to their peers who know no
better than they do. Better they hear the right answers from us
before that occurs.

Even the best parental guidance will have little impact upon
those who are already addicted to drugs. Although patience and
encouragement are crucial, success in curing addiction must start
with a real commitment by the addict. Without this, relapse after
treatment is almost inevitable.

Strangely to those of us who have never been under the
influence of drugs and who only see the harm which addicts do to
themselves, few are ready to make such a commitment. With all its
problems, the world of addiction they live in seems better than
reality -- and as we know, reality in Indonesia can be hard!

Sadly, few addicts are really aware or concerned about the
harm they are doing to themselves. Few consider the threat of
death through overdose or from AIDS or other conditions. The risk
of these harms is greatest among drug users who inject. In
particular, HIV, the virus which causes AIDS, is most efficiently
spread through the sharing of needles -- once the virus has
infected one member of a group sharing needles, the
rest of the group can become infected within days. Experience
around the world has shown that once more than 10 percent of
injecting drug users (IDUs) in any community become infected by
HIV, without extremely effective intervention that rate has
usually exceeded 50 percent within a year.

There are signs that we are almost too late to prevent this
happening in parts of Indonesia. Surveys have shown HIV rates
already as high as 20 percent among IDUs in Jakarta. Extremely
urgent action is needed to address this. We are too late to
prevent these people using drugs; we cannot expect quick success
in attempting to stop most of them using drugs. What we must do
quickly is to reduce the harmful effects, including the spread of
HIV. Again, experience around the world has shown that there are
really only two responses that are effective -- and these can be
very effective, if controversial. The first is to try to
encourage IDUs to stop injecting, usually by providing
alternatives such as methadone, a cheap liquid drug that is taken
orally. For those not ready to change to methadone, providing
easy, cheap access to clean needles is really the only solution.

Neither of these approaches is ideal. But both work. Both will
help ensure that when users are finally ready to make the
commitment to stop using drugs (as most do sooner or later), they
will still be healthy and able to play a productive role in
society.

As we consider our options and look for solutions on the
International Day against Drug Abuse and Illicit Trafficking on
June 26, let us not ignore the large number of our young people
who will not be reached by strident prevention messages. If these
are to survive, they need our support to avoid the harmful
effects of their drug use.