HARM minimisation vs zero tolerance: it’s a debate that just won’t go away in areas ranging from sexual behaviour to illegal drug use.
Those who argue for harm minimisation have to deal with complex, often murky, ethical choices.
Should a doctor who knows their patient is engaging in dangerous, possibly illegal, behaviour simply tell them to stop, or give advice on safer ways of doing what they are going to do anyway?
Such moral grey areas are difficult enough for doctors, but they are far more challenging for politicians who have to grapple with them in the full glare of the media spotlight and in the face of often ill-informed but vocal public opinion.
This is why Australia’s first medically supervised injecting centre is only now getting the formal go-ahead, despite nearly a decade of successful operation.
The NSW government last week moved to end the legal fiction that the Kings Cross centre was a “trial”.
The government said research showed the centre had reduced harms including deaths from overdose, disease transmission via shared needles and the impact of drug use on local residents, all without the predicted rise in drug-related crime in the area.
Yet even now the centre is probably only getting some measure of security because the terminally ill NSW government knows it has nothing to lose.
With less chance of winning the next state election than the proverbial snowball’s survival in a very hot place, Labor can afford to make a few brave decisions before it goes.
Politicians elsewhere are considerably less courageous.
In the wake of the NSW decision and in response to calls for similar facilities to be established in Brisbane and on the Gold Coast, Queensland Health Minister Paul Lucas told the ABC he opposed the very idea of them.
“I do not see a solution where we sit by and say to people, ‘We’ll just let you shoot drugs up your arm where you’re all getting together to do it’, is a satisfactory solution,” he said.
Victorian Premier John Brumby also ruled out establishing an injecting centre in his state, saying his government was “getting on top of” the problem by other means.
Well, I have news for you, boys. As a neighbour of the Kings Cross centre for the past 5 years, I can’t recall seeing a discarded syringe or anybody injecting on the street ― something I certainly couldn’t say about the inner suburbs of Melbourne.
Medically supervised injecting centres are not a perfect solution but the government statistics do paint a picture: in 9 years, the Sydney centre has successfully managed more than 3000 overdoses, distributed more than 300 000 clean needles and syringes and referred nearly 4000 drug users for medical treatment.
And what’s the alternative?
Last year, I saw a young man die on the floor of a local community drop-in centre after shooting up in the toilets.
Distraught staff members said such tragedies have been rare since the opening of the injecting centre down the road.
As one said: “If he’d gone there, he’d still be alive.”
Jane McCredie is a Sydney-based science and medicine writer. She has worked for Melbourne’s The Age and contributed to publications including the BMJ, The Australian and the Sydney Morning Herald. She is also a former news and features editor with Australian Doctor. Her book, Making girls and boys, on the science of sex and gender, will be published by UNSW Press early next year.
Posted 25 October 2010