Dr Sally Wilkins is a Melbourne-based Consultant Psychiatrist who works in forensic mental health, addiction medicine and homelessness.

Last year a new state-of-the-art men's prison called 'Ravenhall', opened in the western suburbs of Melbourne. A private corporation, GEO, has been contracted by the Victorian Government for 25 years to provide correctional services for up to 1300 men at a total cost of approximately $2.5 billion or $100 million every year, until 2042.

As the median age of adult prisoners is 34 years, this means that the young men who will fill this prison for the last few years of the contract are currently around 8 - 10 years old and at primary school.  Some of them are running into trouble right about now.
Is our community really unable to provide interventions for these kids that would block their pathway towards incarceration?

We've just made a $2.5 billion dollar bet that we can't.

It is currently a political winner to be 'tough on crime' rather than 'strong on prevention'. Record numbers of people (currently 6,500) are in our state prisons, for longer periods, with fewer support programs in place. They have minimal if any supervision when they leave.  93% of them are men. Even if they are housed in the most enlightened of facilities, they will inevitably leave with a prison record, and all the negative sequelae of incarceration - both physical and psychological. Many will remain unemployed, marginalised and welfare dependent for months or years.

Hepatitis C (HCV) in detainees who inject drugs is rife across Australia and could be prevented, contributing significantly to reducing HCV prevalence in the general population. People in custodial settings are one of the largest cohorts living with HCV; in 2015, there was a 31% antibody prevalence amongst detainees around Australia.

Australia has committed to eliminating HCV by 2030. To achieve this, an expansion of harm reduction in prisons is essential. A combination of three strategies is needed to achieve this, all of which are supported by evidence.

1. Treating all detainees with HCV antibodies with direct-acting antivirals
2. Introducing needle and syringe programs to prisons
3. Expanding access for detainees to pharmacotherapy

Treating all detainees with HCV antibodies with direct-acting antivirals

In recent years a new interferon-free direct-acting antiviral (DAAs) has been made available through the PBS to everyone living with HCV. This represents a huge achievement for Australia with no restrictions to access as there are in other countries. DAAs are 90% successful at clearing the virus (sustained virologic response) and have little to no side effects. Over the last years there has been an increase in awareness campaigns and medical practitioner training and general practitioners received prescription rights. The number of people reached (19% of people living with chronic HCV) and the increase in general practitioners prescribing (22%) as of 2017 is very encouraging. DAAs do not however provide protective immunity and reinfection can occur.

but you'd never know from the headlines

Stephen Bright, Edith Cowan University and Martin Williams, Monash University

Mainstream media tend to report more stories about illicit drugs than alcohol.

Stories about illicit drugs are also more negative. The media is more likely to frame illicit drugs as dangerous, morally corrosive and associated with violent behaviour, while it frames people who use illicit drugs as irresponsible and deviant.

In particular, the media is more likely to link illegal drugs with violent crimes, sexual assaults and murders than alcohol. This is despite one study finding 47% of homicides in Australia over a six-year period were alcohol-related.

Coverage of the recent Rainbow Serpent Festival in Victoria is one example of how the media have linked illegal drug use with violence. There were reports of alleged sexual and physical assaults at the festival, held over five days including Australia Day. But we'd argue there were no more than any alcohol-related violence and sexual assaults expected at a similarly large gathering on Australia Day.

Why cigarettes, chocolate bars, heroin, gambling or a new handbag feels so good?

Header image Rakicevic Nenad/Unsplash

James Kesby, The University of Queensland

Every day we make a range of choices in the pursuit of pleasure: we do things that make us feel good or work in a specific job because it's rewarding or pays well. These experiences help shape our perspectives on life and define our personality.

Consequently, problems with our ability to manage or maintain our pursuit of pleasure often lie at the root of many neuropsychiatric disorders such as addiction and depression.

Poker machines are designed to tap into our reward centres. krissia cruz unsplash

What's going on in the brain when we experience pleasure?

Pleasure itself – that good feeling you get in response to food, sex and drugs – is driven by the release of a range of neurotransmitters (chemical messengers) in many parts of the brain. But dopamine release in the brain's reward system is particularly important. Dopamine release tells the brain when to expect something rewarding, modulates how rewarding it will be and drives us to seek rewarding things.

Nicole Lee, Curtin University and Jarryd Bartle, RMIT University

Greens leader Richard Di Natale wants Australia to legalise cannabis for personal use, regulated by a federal agency. This proposal is for legalisation of recreational use for relaxation and pleasure, not to treat a medical condition (which is already legal in Australia for some conditions).

According to the proposal, the government agency would licence, monitor and regulate production and sale, and regularly review the regulations. The agency would be the sole wholesaler, buying from producers and selling to retailers it licences.

The proposed policy includes some safeguards that reflect lessons we've learned from alcohol and tobacco. These include a ban on advertising, age restrictions, requiring plain packaging, and strict licensing controls. Under the proposal, tax revenues would be used to improve funding to the prevention and treatment sector, which is underfunded compared to law enforcement.

Cannabis legislation around the world

Reference: Ritter, A., Lancaster, K. & Diprose, R. (2018). "Improving drug policy: The potential of broader democratic participation." The full academic paper and research is available online at the International Journal of Drug Policy. 

We need governments to make better decision about illicit drugs. The alternative is to remain stuck in the same futile cycle.

Every time a young person dies tragically and needlessly at a music festival or dance party, our commentators clamour for our politicians to respond immediately. We make drugs policies on the run. But, policy quick-fixes are mostly ineffective and we find ourselves no better prepared to avert future tragedies or drug-related harm.

We need to change the way drugs policies are made.

We have decades of research that tells us what works and we are continuously building that evidence base. Smarter drug policy would involve making use of that evidence alongside and integrated with the other drivers of policy such as public opinion, and personal experience.

Recently a lengthy 640-page Inquiry into Drug Raw Reform was tabled in the Victorian parliament. The report looked at how effective the state's current laws were in regards to dealing with drugs, and called for a more effective response centred around health and safety.

The committee looked at not only other Australian state and territories, but travelled overseas to other jurisdictions, such as Geneva, Lisbon and Vancouver, to see how the positive impact of their drug law reforms could be adopted in Victoria.

Inquiry into Drug Law Reform

The report considered referring those who were caught with small quantities of drugs to rehabilitation, treating addiction health issue and looking at 'back of house' testing where police, health professionals and harm reduction organisations work together to identify dangerous substances and alert the community where deemed appropriate.

Citation: Hughes, C., Ritter, A., Chalmers, J., Lancaster, K., Barratt, M. & Moxham-Hall, V. (2016). Reproduced with permission: Drug Policy Modelling Program, NDARC, UNSW Australia.

Key messages

1. Decriminalisation does not mean legalisation: decriminalisation removes criminal penalties for use/possession either by law (de jure) or by practice (de facto).

2. There is strong public support in Australia for decriminalisation approaches.

3. The research evidence indicates that decriminalisation of drug use:

• Reduces the costs to society, especially the criminal justice system costs
• Reduces social costs to individuals, including improving employment prospects
• Does not increase drug use
• Does not increase other crime
• May, in some forms, increase the numbers of people who have contact with the criminal justice system (net widening)

4. Many countries around the world have decriminalised drug use and possession in various ways.

5. Australia currently has a mixture of de jure and de facto decriminalisation schemes for use and possession of illicit drugs: but decriminalisation is not universal. Accordingly, many people continue to be sent to court for possession of only minor quantities of drugs.

6. There is an opportunity to expand decriminalisation for drug use in Australia, particularly through de jure decriminalisation schemes targeting all illicit drugs. This may further reduce costs to the criminal justice system and to individuals.

Let me repeat a phrase that has been used so often it is almost a cliché: the war on drugs has failed.

Existing drug policies have increased drug-related harm, punished the vulnerable and the addicted and bolstered organised criminal networks.

Health professionals, lawyers and policy experts have all made the case against current drug policies. Such is the overwhelming expert opinion against our current approach to drugs that words need not be wasted trying to convince you here.

Nevertheless, critiquing current drug policies often provokes an inquisitive – if at times slightly smug – response, "well, what do we do instead?" To some, drug law reform stirs up images of laissez faire commercialisation of drug markets: a 'McHeroin' on every corner. Of course, this is not what professionals are advocating for.

Instead, there is a growing consensus amongst AOD professionals of the ideal legal framework to tackle drug related harm. To put it simply, most experts are calling for Portugal-style decriminalisation model combined with some model of cannabis legalisation.

Drug Decriminalisation

Medical breakthroughs missed because of pointless drug bans

In 1632 the Catholic Church convened a case against Galileo on the grounds that his work using the telescope to explore the nature of the heavens contradicted the church's teaching - the culmination of a long fight that had lasted 16 years.

Galileo was put under house arrest and his research stopped. Some of his inquisitors refused even to look down a telescope, believing it to be the work of the devil. With his life under threat, Galileo retracted his claims that the earth moved around the sun and was not the centre of the universe. A ban by the papal Congregation of the Index on all books advocating the Copernican system of planetary motion - which we use today - was not revoked until 1758.

Three centuries later we have an equivalent case of scientific censorship. In the 1960s and the 1970s the UN effectively banned a whole range of drugs from cannabis, opioids and cocaine through to psychedelics - LSD and "magic mushrooms". They did this in a futile attempt to reduce the use and harms of these drugs, but both consumption and harms have increased ten-fold since then, and many of the negative effects of these laws include the rise of AIDS and the collapse of law and order in Mexico.