* The author wishes to extend her sincere thanks to Diane McKenzie for her assistance with this project.

Table of Contents

Executive Summary ii

1. Introduction 1

2. Drug Use in Canada 6

3. Costs of Substance Use 12

4. The Law Regarding Licit and Illicit Drugs in Canada 15

5. International Drug Conventions and Canadian Drug Law 19

6. Drug Use and Human Rights 37

7. Drugs and Crime 39

8. Correctional Institutions 41

9. Harm Reduction 47

10. Alternatives to the Canadian System 50

11. Conclusions and Recommendations 58

EXECUTIVE SUMMARY

As the UN reaches new international agreements on drugs based on criminalization and punishment, the illegal drug industry has grown to an estimated $US400 billion, fueling organized crime, corrupting governments, increasing violence and distorting economic markets. In many parts of the world, the war on drugs results in the spread of infections (e.g. HIV), violations of human rights, damaged environments and prisons filled with drug offenders convicted of simple possession. As an increasing number of countries around the world desert the war on drugs in recognition of the harms generated by these policies, Canada has instituted a new, thoroughly prohibitionist drug law. The levels of penalties exacted by this law are in conflict with Canada’s own legal protections of civil liberties, as well as of the international legal protections of human rights. Canada’s reasons for adopting such a costly response to her international commitments are described in this paper.

A Brief History

The legal framework for drug control in Canada was laid down in the early part of the 20th century. In 1908, the Opium Act created the first drug prohibition, along with other medicines, and alcohol and tobacco regulations. Other opiates and cocaine were covered in the Opium and Drug Act of 1911 and cannabis was added in 1923. The Opium and Narcotic Act of 1929 became Canada’s main instrument of drug policy. International drug prohibition and regulation through the Single Convention on Narcotic Drugs (1961) and the Convention on Psychotropic Substances (1971) reinforced the artificial division between legal and illegal drugs.

In 1969, the Le Dain Commission of Inquiry into the Non-Medical Use of Drugs discovered that hundreds of thousands of Canadians were convicted of illicit drug possession with lifetime barriers to personal freedoms; sweeping police powers were used largely against youth. The Commission recommended a gradual withdrawal from criminal sanctions against users and less coercive alternatives to the use of criminal law. In the 1980s, Canada’s Drug Strategy (1987) was implemented to address both the supply and demand reduction strategies and programs in enforcement, treatment and prevention programming were funded. The new law, the 1997 Controlled Drugs and Substances Act is soundly prohibitionist and does not reflect the experiences of other countries around the globe. The problems related to criminalizing drug users and its failure to reduce drug availability have not been addressed while the financial and human costs of criminalizing illicit drug use continue to rise.

Drug Use in Canada

The indirect harms and costs of illicit drugs by far outweigh direct harms and are disproportionate to their level of use and are the result of drug policy and legislation, not the drugs per se. The most direct harms occur in high-risk populations such as injecting drug users, street youth, the inner-city poor and Natives.

Illicit drug use increased substantially across the country between 1993 and 1994. Use of cannabis increased from 4.2% to 7.4%, cocaine increased from 0.3% to 0.7% and use of LSD, speed or heroin increased from 0.3% in 1993 to 1% in 1994. No recent national data are available to determine if this trend continues. An (under) estimated 132,000 (7.7%) Canadians who use cocaine, LSD, speed, heroin or steroids have injected drugs. Of these, 41% have shared needles.

Drug Problems In High Risk Groups

Indigenous Canadians: Alcohol and drugs are the biggest health and social issues facing some aboriginal people with 65% to 80% of people in some communities experiencing problems. The leading cause of death for Indians and Inuits are injury and poisoning with patterns of violent death that are 3-4 times greater than national norms. Two-thirds of natives who meet unnatural death were drinking prior to death, compared with 45% of non-natives; deaths with alcohol or drug involvement as the primary cause are five times greater for natives than non-natives. The suicide rate for Saskatchewan Native children was 27.5 times that of other Canadian children and Native youth are two to six times greater risk for every alcohol-related problem than their counterparts in the rest of the population.

Street Youth: Adolescents leave home to escape physical, emotional and sexual abuse or neglect in the home. Once on the street, they adopt many high risk behaviours including high levels of licit and illicit drug use and needle sharing. A 1989 national study showed that 1 in 4 street youth used cannabis daily, 4% used cocaine daily and 4% used LSD daily. A recent study in Montreal found that half of street youth injected drugs and that suicide and drug overdose was so prevalent that the children studied were 12 times more likely to die than their peers.

The Inner-City Poor: Vancouver: A health emergency was declared as a result of the rapid increase of HIV infection in injection drug users in Vancouver East where the prevalence rates increased from 20% in 1997 to a world-wide high of 25-35% in 1998. In addition, Vancouver has the highest levels of overdose deaths in Canada, with more than 300 this year and more than 2,000 since 1991. These high levels of infection and other drug-related problems are linked to the poverty and social dislocation of residents in down-town Vancouver.

HIV/AIDS and Injection Drug Use: Injection drug use poses direct risk of HIV and other (e.g. hepatitis) infection through sharing of contaminated equipment. Non-injection drug use poses indirect risk of infection in that it can increase the likelihood of unsafe sexual and drug-injecting practices. The incidence rates (rate of new HIV infection) in some Canadian cities are very high; the 10% incidence rate in Vancouver is the highest in the Western world. Montreal has an incidence rate of 7%, as does Ottawa. Some regions of Canada report higher incidence rates, especially among Natives. The World Health Organization has cautioned that once levels of infection among injection drug users reach 10%, the epidemic can become explosive for the entire population of that region.

In 1997, the Federal government released an Action Plan on HIV/AIDS and injection drug use that has had, as yet, little action. A comprehensive harm reduction approach to AIDS and drug use should be in place immediately to keep rates of HIV infection from increasing if we are to keep the level of infection low in the general population.

Costs of Substance Abuse

An estimated 732 Canadians (.4% of total mortality) died from the use of illicit drugs in 1992. Of these, 42% were suicides, 14% were from opiate poisoning, 9% were cocaine poisonings and 8% were AIDS-related deaths in injection drug users. In addition, there were 7,100 hospitalizations -- half of which were for drug psychosis, assaults and cocaine abuse.

In total, substance abuse cost Canadians more than $18.4 billion in 1992 ($649 per capita), which is 2.7% of the Gross Domestic Product. Current estimates of the economic costs of illicit drugs placed at $1.37 billion ($48 per person) must be interpreted with caution and may be substantially higher. This estimate attributes $823 million to lost productivity due to morbidity and premature death and $400 million for law enforcement. Direct health care costs due to illicit drugs are estimated at $88 million.

While drugs are a factor in many crimes, their role is unclear. Users obtain their drugs from a market that is highly priced and violent, and where crime is frequent. Illicit drug use contributes to crime and law enforcement costs in a number of ways including enforcement of drug laws per se, and use is implicated in property crime and crimes of violence such as those committed over drug territory.

Federal Drug Law

The most important federal statute dealing with illicit drugs is the Controlled Drugs and Substances Act (CDSA) which governs six common offences such as possession, trafficking, cultivation, importing or exporting and "prescription shopping". The CDSA consolidates previous drug acts and modernizes Canada’s drug control policy. It fulfills obligations under several international protocols and covers offences to do with property and proceeds of drug offences. The most important legal change in the CDSA set punishments for possession, distribution and production of cannabis apart from other illegal drugs. If the amount of cannabis possessed is less than 30 grams and the amount distributed is less than 3 kilograms, maximum jail terms are reduced to six months and 5 years respectively. The maximum for heroin and cocaine possession remains at seven years and a maximum term of life imprisonment for distribution.

Critics suggest that although CDSA leaves the impression that enforcement is directed at large scale traffickers of hard drugs, it will be applied for possession of small amounts of cannabis, as before. Several new offenses have been created for amphetamines, khat and hallucinogens. Another criticism is that the scheduling of the drugs do not rationalize the relationship between the harms posed by drugs and the punishments. While claiming the need for compliance with international treaties, the Act does not consider alternatives to conviction or punishment set out in these treaties or conventions for removing criminal penalties for possession of certain drugs for personal use. The CDSA also preserves the special enforcement provision for arrest, search and seizure in drug cases, making drug use more susceptible to the harms of adulterated drugs or drugs of unknown potency. The new law exacerbates some of the worst excesses of Canadian drug policy and may perpetuate the violence associated with the drug trade.

International Drug Conventions and Canadian Drug Law

Three international Conventions on illicit drugs cover cannabis, cocaine, heroin , other psychoactive substances and their precursors: the Single Convention on Narcotic Drugs, 1961, the Convention on Psychotropic Substances, 1971, and the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988 (Vienna Convention).

The Single Convention limits the production and trade in prohibited substances to the quantity needed to meet the medical and scientific need of the State. Each State creates the necessary legislative and regulatory measures for establishing the controls within their own territories to fulfill the commitments of the Convention. The measures prescribed by the Single Convention are the minimum that States must adopt; there is nothing to prevent them from adopting more strict or severe measures. The three Conventions recognize the particular features of national, legal and judicial systems and specify that the measures adopted by a State will respect these systems.

Cannabis: The Conventions treat cannabis as a narcotic, which it is not. During the past thirty years, researchers around the world have examined the effects of cannabis, dispelling many myths about the negative effects due to its use. The recent discovery that the body makes its own version of THC to regulate pain and nausea has encouraged research on its therapeutic effects. In November, 1998, the medical journal Lancet published an editorial on cannabis stating that moderate use of cannabis has little effect on health, and decisions to ban cannabis should be based on other considerations.

Cannabis and International Treaties: The Single Convention of Narcotic Drugs (1961) as amended in 1972 is regarded as the main obstacle to changes in domestic cannabis policy. Use and commerce in drugs covered under the Single Convention are restricted to scientific and medical purposes while possession and use of cannabis, hashish and extracts of cannabis are offences. The deliberate vagueness of some treaty provisions, however, make them more flexible than sometimes interpreted. For example, analysts have asked if the provisions of the Single Convention for cannabis possession are aimed at small-scale personal use or large-scale trafficking. Some suggest the convention demands only possession for the purpose of illicit traffic, others believe that a ban on personal use is required, while still others say the question must be answered in each country.

While no dramatic changes in cannabis policy have occurred through legislation, changes have taken place through policing and the courts. At least two decisions in Ontario and British Columbia concluded that cannabis appears to be a much less dangerous drug for its consumers than either alcohol or tobacco. In 1997, Christopher Clay, a young owner of a hemp store in Ontario tested the Canadian law for possession, cultivating and selling marijuana plants. Although Clay was found guilty for possession, Judge McCart’s decision supported the arguments by counsel that the harms associated with marijuana use did not warrant extensive marijuana policies. Similarly, Judge Sheppard acquitted Terry Parker, an epileptic who used cannabis for therapeutic purposes, of charges for possession and cultivation. Parker was convicted for trafficking but received one year probation. Sheppard’s decision stated that both the Narcotic Control Act and the CDSA are over broad and unconstitutional and violate the Canadian Charter of Rights and Freedoms. Despite these decisions, other medical marijuana users will have to take their cases to court until a decision is made by a higher court or the Federal Parliament moves to change the law.

Although Canadian organizations are slow to support medical marijuana, many US health and medical organizations have taken favorable positions. In November, 1998, seven US states voted on access to medical marijuana and six supported access.

Cannabis policy in Canada serves two main functions: to minimize health and safety hazards and to minimize social costs and adverse individual consequences that result from efforts to control use. While policy specialists debate the pros and cons of changing the laws on cannabis, the police and judiciary have created a de facto softening of penalties for possession, not the politicians. The available evidence suggests that removal of jail as a sentencing option would lead to considerable cost savings without increasing rates of use. The majority of Canadians -- 69%-- do not support jail sentences for simple possession of cannabis. While diversion of cannabis offenders to treatment or community services should be available, diversion will not reduce the load on courts and would not affect the consequences of having a criminal record.

A change in Canada’s cannabis laws could take several forms such as making possession a civil offense with a fine and no criminal record, diversion to treatment or community work, with a criminal conviction and record. The federal government could also concede jurisdiction over cannabis possession to provinces which would establish their own control mechanisms. Another approach is the de facto decriminalization of possession, allowing the use and purchase of marijuana in coffee shops as in the Netherlands. A final approach regulates cannabis to control the sale and distribution of the drug. The best option for Canada appears to be the creation of a civil offense for cannabis possession under the Contraventions Act. In 1997, an Angus Reid Poll found that the majority of Canadians (71% ) support medical marijuana and half of respondents (51% ) support decriminalization.

A number of jurisdictions have tried to make cannabis control more rational and cost-effective through depenalization. In all of the cases where de facto decriminalization of cannabis has occurred, reduced financial and social costs were achieved without an increase in the risks to the community from drug use in general. Other, longer term benefits have stemmed from separating high and low risk drug markets.

International Treaties and Other Drugs: Canada’s drug law does not prohibit all possession or use of illicit drugs. The regulations to the CDSA allow the prescribing of some otherwise illicit substances for treatment or therapeutic purposes. One example is the prescribing of methadone to drug users. Another is the prescribing of heroin under restrictive conditions for therapeutic purposes. Other countries have considered the issues of the controlled availability of heroin to drug users within a medical model to deal with the inadequacy of methadone programs. Discussions are currently underway to open the door for heroin trials in three Canadian cities: Montreal, Toronto and Vancouver. The legitimacy of these trials under the international treaties has been established by other countries, such as Australia, that started their own trials. In 1991, it was concluded that a trial involving the controlled availability of opioids, including heroin, would not place the country in breach of international treaty obligations if it were limited exclusively to medical and scientific purposes.

The Single Convention requires countries to have penal provisions for "possession", although it could be argued that possession is only in the context of distribution. Since then, Canada has ratified the 1988 UN Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances which provides that countries adopt measures to establish the possession, purchase or cultivation of narcotics for personal consumption as a criminal offence. These measures are subject to the constitutional principals of each country. The Canadian government could defend moving away from a policy of total prohibition on the ground that continued criminalization offends the fundamental principal of restraint in the use of criminal law. The second qualification -- the obligation to create crimes of personal consumption of drugs -- only applies to occasions when possession is contrary to the provisions of the 1961 Single Convention. In short, these conventions, as written, allow for specific exceptions to prohibition. These Conventions also allow countries to amend or withdraw from them by denunciation. Therefore, Canada may choose to amend or to denounce these conventions on the basis of other considerations, not by the terms of the conventions themselves.

In 1998, a special UN session to discuss strategies for combating the supply and demand of illicit drugs. Although the summit was to examine current strategies and address alternatives, the delegates agreed to finance a 10 year plan to eradicate opium poppy and coca plants worldwide. They also promised to curb money laundering, examine the growth of synthetic drug manufacturing and use, increase judicial cooperation including extradition and tighten controls over precursor chemicals used to make illicit drugs. The summit prompted a debate among drug consuming and drug producing countries and the value of demand reduction versus supply reduction as anti-drug strategies. Worldwide protest of the UN drug summit was carried out in several cities around the globe.

Drug Use and Human Rights

Most international treaties and conventions, like national drug laws, have not been examined with respect to their compliance with human rights agreements. Policies that are intended to reduce drug-related harms are most effective in supportive environments. This has resulted in increased attention paid to public health and international human rights law in an attempt to create such an environment. In this context, its is widely agreed that human rights law should apply to drug policies as to all other public policies. Drug legislation can be compatible with human rights objectives if it seeks the highest standard of health, prevents the spread of disease from drug use and ensures public safety. In short, the "drug problem" must be recast in such a manner that politicians understand that drug use, health and well-being are as much about protecting human rights as they are about preventing disease or compliance with international drug treaties.

Drugs and Crime

Heavy substance use is associated with a criminal lifestyle which includes such characteristics as aimlessness, self-absorption and an inability to relate to other people. The criminal lifestyle and risk-taking inherent in it suggests that drugs would be important facilitator of crime and as a way of coping with the consequences of the lifestyle. Intoxication results in carelessness by victims and perpetrators, illegal activities increase the likelihood that a firearm will be used and can result in violence and, short-term economic opportunities of back markets divert youth to crime -- cycles that are hard to break.

The most common form of intoxication that increases levels of aggression is due to alcohol while crimes related to the need for money and drug distribution are associated with illicit drugs. The extent to which these crimes would be reduced if the drug laws were changed would depend on consumption levels, the pharmacology of the drug and its relationship with alcohol.

Illicit drug-related crime: Drug crime involves illicit substances such as possession and supply. In 1997, cannabis offences accounted for 7 in 10 of the reported 66,521 drug-related incidents. Cannabis offences grew steadily at about 6% annually since 1991. Continuing the downward trend since 1992, cocaine offences dropped in 1997 (-1.6%). After a large increase in 1996 (+8%) offences involving other drugs such as heroin and amphetamines increased by 1% in 1997. The highest level for drug-related offences is in the Yukon Territory, followed by Northwest Territory and British Columbia. Prince Edward Island has the lowest rate. In 1991 and 1992, 51 people were killed in connection with drug disputes. In 1992, 31% of those accused of personal robbery and 40% of those accused of commercial robbery were on a substance during the incident.

Drug-related Violence: Drug disputes, especially over dealing territories, give rise to violence and sometimes death. Without the level of gun possession seen in the United States, Canadian drug-related homicides remain low compared to its Southern neighbour. This has changed somewhat in Vancouver, due to an increase in territorial battles and in Quebec, with deaths involving bombing by biker gangs.

Drug Use and Correctional Service: The increasing numbers of drug users imprisoned over the last twenty years means that prisons are the single largest response to the drug problem in many countries. A 1989/90 study by Correctional Services Canada found that more than 10% of 371 prisoners used drugs every day in the 6 months before being incarcerated and 17% had regular drinking binges. Sixty-four percent of offenders said they used alcohol or drugs on the day of their crime. Studies in other countries found that 20-30% of prisoners injected drugs at least once a week before committing the crime that sent them to jail. More resources appear to be used in moving drug users through the criminal system than on any other form of management, medical or social.

Since the early 1970s, drug offences have accounted for more than a third of the growth in the incarcerated population and since 1980, the incarceration rate for drug arrests has increased 1,000 percent. Twenty-five percent of the new inmates in New York State are "drug only" offenders, with no record of other types of crimes. Canada has the highest number of drug arrests per capita of any nation other than the United States. There are currently about 1200 inmates serving time for drug-related offences in Canadian federal prisons (offenders who receive more than 2 years of confinement) and several thousand serving time for drug-related crime in the provincial system (less than 2 years). Canadian drug legislation and enforcement has been described as having "a bite worse than its bark". At a cost of $50,000 per inmate per year, it is clear that resources could be better spent.

Drugs in Prison: There is extensive drug use and drug dealing in prison. In 1995, a survey of 4,285 federal inmates found that 40% used drugs since arriving in prison. This occurs because the climate of prohibition allows an economy that generates high income and guards and other staff can be offered high pay for assistance. The result is an economy that is almost perfect for the prison environment, especially since many of the participants have been involved in dealing before entering the institution.

HIV/AIDS and Hepatitis Seroprevalence: There is now evidence of the rapid spread of hepatitis B and C in prisons, pathogens found in persons with HIV and are passed through blood or semen, or both. Three studies in Canadian prisons found seroprevalence rates of between 28% and 40%. In correctional institutions, hepatitis-positivity is a marker of injection drug use. Taken together, these data strongly suggest that we should expect to see a marked rise in HIV prevalence in our correctional institutions over the next several years.

Responding to Drug-Related Harm in Prisons: Issues raised by HIV/AIDS and drug use in prisons were studied extensively by the Expert Committee on AIDS in Prisons in 1992-93. The committee recommended making full-strength household bleach available to inmates, making sterile injection equipment available and providing injection drug users access to methadone. It emphasizes that the adoption of a harm-reduction approach does not mean condoning drug use but rather discourages unsafe injecting behaviour. It concludes by saying that it will be essential to reduce the number of drug users who are incarcerated.

The Prison System’s Response: Many of the Committees recommendations were accepted, including making bleach available in all prisons. However, methadone and needle exchanges would not be made available in prisons. Correctional Services Canada later announced a strategy to combat drugs in federal penitentiaries that was inconsistent with the Expert Committees recommendations. Among other measures, the use of random urine testing for drug use has increased in federal institutions, visitors are searched more often, visitors who attempt to bring in drugs not only face criminal charges but may be barred from further visits. These measures have been criticized as ineffective, costly and counterproductive. In 1995-96, Correctional Services spent $1,200,000 for its urinalysis program, $1,000,000 for other components of its drug strategy, but only $175,000 for its entire AIDS program.

The World Health Organization recommendations on the control of AIDS in prisons state that health care within prisons should be equivalent to health care in the community. For those who feel that we have begun to make headway in introducing harm reduction as an acceptable policy in our countries, the situation in prisons should make us realize how much is yet to be done. Reducing drug-related harm in society means reducing such harm in prisons too, and in that regard we have so far clearly failed.

Alternatives to the Canadian System

Several countries provide examples of alternatives to the present Canadian system.

United States: The US enforces one of the most extreme form of total drug prohibition in the world. The result has been: extremely high levels of drug use, despite some decreases in sections of the population; escalation of costs; extremely high prevalence of HIV and other pathogens especially among drug users, and rapid prison expansion. In 1980, the federal budget for drug control was approximately US$1 billion, and state and local budgets were 2-3 times that. By 1997, the federal drug control budget reached $16 billion, two-thirds of it for law enforcement agencies; state and local funding also increased to at least that level.

United Kingdom: Physicians in the United Kingdom are permitted by law to prescribe any drug except opium for their patients. The government's statutory Advisory Council on the Misuse of Drugs stated in 1988 that AIDS is a greater threat to public health than drug misuse, and recommended that drug services modify their policies to make contact with and change the behaviour of the maximum number of drug users even when they are still actively using drugs. The Mersey Model of harm reduction includes prescribing drugs, syringe exchange, explicit education and a strong police role. The Mersey Model has been followed successfully in most parts of the United Kingdom, which has a national average of only 1% HIV infection in injection drug users. The police policy of "cautioning" for small amounts for personal use has now been extended to all drugs and is practiced throughout the country.

Switzerland: In order to avoid the mistakes of the infamous Needle Park, the Swiss government agreed in 1992 to take over some responsibility for drug issues from the cities. In January, 1994, the Swiss government began a multi-year, multi-city scientific trial to provide drugs to long-term dependent users to assess the effects on their health, social integration and behaviour. In 1997, the heroin maintenance experiment was declared a success: crime dropped by 60%, unemployment by 50%, and significant public funds were saved due to a reduction in the costs of criminal procedures, imprisonment and disease treatment. As a result, the Swiss Government is extending the heroin trial.

One innovative harm reduction approach being practiced in Switzerland, the Netherlands and Germany involves toleration by authorities of facilities known as "injection rooms", "health rooms", "contact centres" or similar terms. In 1987, syringes became available in pharmacies and, in 1991 a nation wide syringe exchange and availability program that includes dispensing machines was initiated. This program now includes syringe exchange in all prisons and heroin distribution in one prison. Methadone treatment programs also became increasingly available during this period. These comprehensive approaches have made Switzerland an outstanding example of the cost-effectiveness of pragmatic approaches to drugs.

The Netherlands: The main objective of drug policy in the Netherlands is to reduce the risks that drug abuse poses for the users themselves, their immediate environment and society as a whole. Although the risks to society are taken into account, the government has tried to ensure that drug users are not caused more harm by prosecution and imprisonment than by the use of drugs.

In a number of Dutch cities there is undisturbed sale of marijuana in coffee shops, where the use of alcohol and hard drugs is not allowed. The authorities monitor the coffee shops and youth centres where marijuana trade occurs to ensures that large quantities are not sold, no sale of other drugs, no advertisements, no encouragement to use and no sale to minors. Dutch drug laws have not been followed by an increase in the use of cannabis products. In fact, by keeping cannabis dealing away from the hard drug market and by honestly addressing the myths associated with its use, it appears to have become less attractive to young people.

The Netherlands is one of the birth-places of harm reduction; agencies began methadone prescribing programs in the 1970s, expanding and liberalizing these in the 1980s to deal with hepatitis, HIV, drug-related crime and other harms ("low-threshold programs"). In addition to drug rooms and "coffee shops", Rotterdam has also informally adopted a tolerance area known as the "apartment dealer" arrangement. Following this policy, police and prosecutors refrain from arresting and prosecuting dealers living in apartments providing they do not cause problems to their neighbours.

Germany: At the local level, the large German cities follow a policy of harm reduction. Cities such as Frankfurt, Amsterdam, Hamburg and Zurich have signed the Frankfurt Resolution which states that attempts to eliminate the consumption of drugs in society has failed, that criminal prosecution should focus on combating illegal drug traffic and that harm reduction policies should be pursued to permit drug users to live a life of dignity.

Frankfurt offers a fine example of a comprehensive harm reduction approach to the problems of a large city. It has created a readily accessible network of services for drug users ranging from day-or-night rest areas, to needle exchange programs, to the establishment of "safe injecting rooms" where heroin users can inject themselves in a clean, stress-free environment. Public health and social service workers find that it is easier to provide services when drug scenes are readily accessible and relatively static. Several German cities are preparing to start a trial of heroin prescription to users. These trials have the support of the majority of the country’s police chiefs.

Australia: Until the mid-1980s, Australian drug policies and programs closely resembled those of Canada. Unlike Canada, however, the Australian response to the AIDS threat was rapid and pragmatic. National and state advisory committees on AIDS and drug use were set up early. As a result, Australia has a low level of HIV infection in drug users and there is very little spread of infection in this group.

In 1989, The Legislative Assembly of the Australian Capital Territory (ACT) appointed a select committee on HIV, illegal drugs and prostitution. In 1991, the committee concluded that current policy with regard to controlling and/or reducing the use of illegal drugs might not be effective. The committee considered alternative policy approaches, and Members visited the Merseyside area where they were impressed with the success of the prescribing approach used there. This began a process which resulted in a proposal for a heroin prescribing trial which is widely supported by politicians, health-care workers and the community.

In the early 1990s, South Australia and the Australian Capital Territory (ACT) made the simple possession of cannabis into civil offence through an expiation (fine) system. Revisions to the scheme are in progress and Australia is considering a national program of cannabis policy reform.

With its rapid and pragmatic response to HIV and its willingness to consider alternatives to prohibition, Australia provides an example of a federation willing to focus on the reduction of drug-related harm at the national and regional level.