What a difference a day makes. Last Thursday I went to work happy, a doctor going about his business of trying to promote and improve health, and reduce illness and harm, amongst a group of people generally marginalised by their community. Then on Friday, thanks to Bronwyn Bishop, I discover I am part of the “drug industry“, helping keep people chained to their drug habit so I can make a living! I never realised before what a greedy bastard I was.

Equanimity was only slowly restored when I meditated upon the following.

I practice and teach evidence based medicine, so at any time I must be prepared to abandon any practice, no matter how cherished, if the best data says it is no longer relevant. Most, though not all, of my colleagues in the field do likewise. Harm reduction (HR), the model in which I and most (but not all) colleagues work, has underpinned all Australian drug interventions for 20 years, until the current Federal government began to talk of “harm prevention” (undefined) recently.

Given that all humans will die, health care is all about palliative care and harm reduction. If we want to be brutally frank, harm reduction does not preclude abstinence, and many of my patients seek and attain abstinence from a variety of chemicals. But with HR, we have somewhere to go if they cannot or will not be abstinent for the moment, whereas with the current zero tolerance (ZT) fad, I should not see them until they take the oath of abstinence.

In practice, for example, many young cannabis users will entrench their use when told to stop, but will stop using in their own time if the focus instead is upon them as people, with health and other problems, in a health promoting environment. The best available evidence tells us that no matter how much we as professionals, or the user’s family, believe abstinence is necessary, the user must see that in their own terms.

In a ZT model, they should be punished for being stubborn, whereas in an HR model, there is still much that can be done, keeping the person in the health system, and in many cases leading them to abstinence in time. This is called respecting people’s right to disagree with others, punishment tends to do two things. It keeps people away from health services, but does not stop drug use and so harms increase, or it encourages people to lie about what they can do or want to do, without stopping use, so harms increase. Perhaps the third thing is it makes some politicians feel that the issue has been addressed, whereas the problems just go away, multiply and re emerge on someone else’s watch, punishment is expensive.

Taking away all the children from drug users as proposed (though interestingly, not excessive alcohol or pill users, because these are legal) will take us back to the poor houses of Dickens days, whereas treatment of drug problems usually keeps families together, and returns a much bigger bang for the taxpayer’s buck. Jail costs the taxpayers up to $80 000 per year, increasingly going to private corporations, whereas treatment costs far less (even a year of rehab costs about $30 000, with less intensive interventions far less than that) and has a better rate of success in addressing both drug use and crime.

Unless punishment is what you were after all the time, whilst governments often dole out money from separate buckets, some for cannabis here, some for all illicits there, some for tobacco or alcohol, most real humans maintain the right to be complex. They often use many drugs, from coffee and tobacco to alcohol and amphetamines, and indeed at a chemical level the human brain has no idea which drugs are licit or illicit.

We have brain receptors for opioids and cannabis because our brains make their own; we cannot function without our cannabis-like compounds, in fact.

Most clinicians (but not all) are aware of this and treat real complex people with all their problems, and aim to promote health and reduce harm, if one was serious about the damage done to kids by parental drug use, then addressing alcohol and benzodiazepine (sedative/sleepers) use would be number one, both because of the number of people using these agents and because their use can lead to long periods of inattention, amnesia, poor judgement, risk taking and poor driving, over 24 hours and more in the case of heavy use of benzos. Clinicians are aware of this, but this committee glosses over the issue, as if child neglect or abuse secondary to alcohol intoxication is somehow better than that due to amphetamine use. Why all the alcohol bans and other hoopla in the NT then – it’s only grog? These guys cannot even keep to their own story.

My balance restored, I reflected upon what I had learned from this report, and it is this: the sooner the health system takes real control of managing alcohol and drug problems, and takes the political football away from politicians, the better it will be for almost all Australians. We will have happier healthier people, pay less of our taxes building jails and snooping on our citizens, and live in a more inclusive, egalitarian community.

Bronwyn may not desire this, because a few people may still use drugs, but I think most of us do.