The introduction of new legislation in the ACT means those found in possession of minor amounts of illegal drugs will face fines rather than jail. This change could be viewed as yet another example of Woke legislation from the Woke capital of Australia, or an attempt to face the realities of modern life.

In late 2023, there were two drug-related deaths while 10 others were hospitalised at a Sydney music festival. This year has already seen similar numbers after a Melbourne festival reported 9 admitted with suspected MDMA overdoses. Several were put into an induced coma.

This has renewed debate about pill testing at these events. One view is that this approach would reduce deaths, another is that it would encourage more to take drugs in the mistaken belief they are safe. Testing, as well as being expensive (paid for by whom?), is unlikely to be reliable, especially given the quality control of homemade pills is non-existent where one pill is often not the same as the next in one batch.

Other countries, including the Netherlands, a handful of European nations, New Zealand, and Canada have introduced general drug testing programs. The ACT has already introduced general free testing through its CanTEST program which has been available since July 2022. The Greens have advocated setting up 18 testing centres across Australia, which is estimated to cost $18 million over 4 years.

The ACT government has taken the next controversial step by decriminalising the possession of small amounts of cocaine, methamphetamine, MDMA, and heroin along with substituting fines. The Federal Opposition is attempting to override this legislation, as it did years ago with euthanasia in the Northern Territory.

In Australia, surveys have shown there is an 80 per cent popular support for the lesser step of decriminalising marijuana possession, and several states have made that move. In 2019, full decriminalisation legalisation was enacted in ACT and Northern Territory. The drug was legalised in Western Australia in 2004, but re-criminalised in 2011. For possession of small amounts, fines were to be imposed instead of a criminal record or jail term in Queensland, Victoria, New South Wales, and South Australia although larger quantities still led to jail. Whilst most marijuana use is recreational, heavy consumption in the young can be associated with permanent brain damage and paranoia.

South Australia was the first state to decriminalise the possession and cultivation of small amounts of cannabis in 1987, substituting a fine. An unintended consequence was the non-payment of fines resulting in an increased number of convictions and more people going to jail. An alternative method of payment has resolved this issue. There is clear police support for the approach and overall consumption has fallen from 18 per cent of the population to 11 per cent. The ACT introduced a similar scheme in 1993, the Northern Territory in 1996, and Western Australia temporarily in 2004, all resulting in a decline in use. This may perhaps suggest an improvement. An alternative explanation is that different drugs are now more fashionable.

Overseas, the main template for the changing approach has been Portugal. In 2001 it introduced highly controversial legislation to decriminalise (as opposed to legalise drugs), the difference being that drug taking is still illegal and subject to fines and enforcement until legalised. Part of the program enforces rehabilitation programs along with implementing ongoing significant penalties for drug growers, dealers, and traffickers. The fear has always been that decriminalising drugs would lead to an explosion in use and demand for services.
The Portuguese experiment has been the topic of much discussion with both proponents and opponents guilty of misrepresentation of outcomes. There is no doubt that the incidence of HIV, Hepatitis B and C, and drug-related deaths (due to overdose, suicide, and trauma) has declined and the feared increase in use has (debatably) not occurred. In particular, drug use has declined in the 15-24 age group which has been identified as the population most at risk. However, a range of changed social and health circumstances may also be an explanation. Heroin use declined, but this was already occurring prior to the changes as drug-taking ‘fashions’ change. In America, overdose deaths from heroin fell from 15,000 in 2017, to 9,000 in 2021, while total deaths from opiates doubled to 80,000 over that period.

Predictably, the number of drug-related imprisonments fell by two-thirds, and those who committed crime whilst on drugs or attempting to fund their habit, fell from 40 to 20 per cent. An increasing body of evidence from Portugal and other countries has concluded that punishment has little deterrent effect. From the health viewpoint, the latest statistics supporting changes are not promising. Portuguese overdose rates have doubled over the last 5 years, to a 12-year high.

By 2016, there was some degree of change in the law in 30 countries, including Canada, Uruguay, and some states of the US and Australia. The financial argument is that it reduces the cost of police and court time and imprisonment, estimated in Australia in 2016 at $1 billion for law enforcement alone (compared with around half a billion dollars spent on prevention and treatment). The average cost of imprisonment is $300 per person per day. It will also, theoretically, reduce criminal networks associated with the drug trade, and will allow the government to tax the supply for a new source of revenue.

In 2019, there were around 150,000 cases of drug possession countrywide, taking an average of 9 hours of police time to process to court. There were 120,000 drug seizures, with increases in amphetamines and derivatives, a fall in MDMA, cannabis increased, heroin remained stable, and cocaine reached record levels. There was over 10,000 kg of cannabis, nearly 10,000 kg of meth, 3,000 kg of MDMA, 1500 kg of cocaine, and 200 kg of heroin recorded with an estimated street value of $10 billion. Annual consumption of ice is estimated at more than 11 tonnes. The concern with ice is that it is cheap and easy to make and is highly addictive in nature which may lead to a generation beyond help. Comparative figures are 4.6 tonnes of cocaine, 2.2 tonnes of MDMA and nearly a tonne of heroin, the total with an estimated street cost of over $11 billion (compared with $15 billion spent on alcohol).

Wastewater sampling in Australia shows there is an increasing city/country divide in use, with cocaine and ecstasy the major city habit, compared with amphetamines, particularly ice, and heroin in the country. The surge in ice use in regional areas has overwhelmed rehab options.

An estimated 43 per cent of Australians have used an illicit drug in their lifetime with 3.5 million cases recorded in the last year. Overdose deaths have remained stable at around 1,800 per year. Since 1999, all six states and 2 territories have progressively introduced rehab programs for those in possession of drugs for personal use that they can be diverted to assessment, education, and or treatment. De facto decriminalisation avoids charges, a criminal record, and loss of employment. So far, the rate of re-offending has proved acceptable, the health consequences are better managed, the criminal system is less burdened, and overall costs have been reduced. This has led to an estimated saving of $3 per dollar spent.

Demand for rehab services exceeds the state-supplied options. Private facilities, both in Australia and overseas, are expensive. Private inpatient treatment is typically around 1 month while figures show that three-quarters complete the rehab course and only a quarter remain drug-free after 5 years. Residential treatment, with greater attention to lifestyle (typically around 2 months), has a 50 per cent completion rate and again a 25 per cent success rate. Detox with medication and psychotherapy (around 6 months), has only a third completion rate and less than 20 per cent success rate by 5 years. Outpatient counselling (around 6 months), has a 40 per cent completion rate and less than 20 per cent success rate. The stats do not seem impressive but other factors do suggest improvement. Studies found reduced drug use, improvement in employment, improvement in relationships, and improved health, both mental and physical.

The current, rapidly expanding, ice epidemic is particularly challenging with its high addiction potential. Statistics suggest 6 per cent of the population have used amphetamines at some stage, over 1 per cent in the last year, with perhaps up to 50 per cent of those now using ice. Because of its more ‘benign’ image, there has also been a consistent increase in cocaine usage which is associated with a rise in cardiovascular deaths, car crashes, and suicide. Traditional rehab methods have proved even less successful than for heroin and a new, community-based program called Matrix has been introduced. Initially trialled in America for cocaine addiction, it is now achieving up to 50 per cent success for ice rehab, and the federal government has invested $250 million in a national ice strategy.

Overall, the worldwide trend has been to decriminalise drug taking and convert it from a criminal to a medical problem. This seems to have many benefits, not only to health, but social well-being, reduction in crime and reduction in costs to policing, the legal system and imprisonment. Police forces in many countries would prefer this approach, as ‘the war on drugs’ has plainly not worked.

The Australian ‘experiment’ is about to begin in the ACT. Should the state government continue to follow the lead of California, the Woke capital of the world, it may end with the same problems which include increasing poverty, homelessness, drug overdose deaths, crime, unemployment, and looming bankruptcy.

Pill testing at concerts is a peripheral problem, underlying the current dysfunctional situation are the bigger questions – why do people take drugs, and what are more effective rehab strategies?

Dr Graham Pinn, FRCP, FRACP, FACTM, MRNZCGP, DCH. Consultant Physician