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.