Governing Heroin in Australia: Hierarchical and associative governance, adapting for contextual suitability is a case study of the Kings Cross Medically Supervised Injecting Centre and the potential for other associative governance models to cooperate with the traditional hierarchical response in heroin policy creation.
1.0 Executive Summary
This case study analyzes the role of non-state actors and networks and the importance of different modes of governance in heroin policy such as the Sydney’s Kings Cross Medically Supervised Injecting Centre (MSIC), which demonstrates that top down and persuasive models in heroin policy making, are not the only policy type and that other possibilities need to be investigated and invested in by the Australia government.
Academic literature indicates that top down and persuasive governance, are effective when in the right circumstances. Caulkins (2002:5) suggests that Australia’s preventative measures did help create the ‘heroin drought’ of Australia, however, other academics such as Dray (2008) suggest that the macro level disruptions to drug supply barely changes the micro level distribution and uptake of new heroin users. Regardless, Caulkin (2002:4) aptly describes hierarchical measures such as strategic law enforcement does and has slow the contagious drug cycle, that starts as an emerging market for experimental and leisure users of drugs and evolves into a mature market of addicted users. Sonja Wälti, Daniel Kübler (2003), David Moore (2004) and Jonathon Caulkin (2002) thus suggest expanding from top down and persuasive governance to utilising a spectrum of governance models. Associative governance, is very effective in heroin policy, because it feels democratic, more authentic and suggests a higher level of expertise has gone into the policy creation, which leads to greater acceptance (Wälti, 2003:194)(Moore, 2004).
The case study’s argument is that associative governance should be currently prioritized in creating government heroin policy, this was accomplished by distinguishing the associations capable of working with the government and by analyzing the successful and unsuccessful policies. Success was based upon how they were metagoverned and their impact on heroin issues. This studies strengths and weakness derive from its relevance to Australia, the policy can be picked up by Australian government but may not be the international greatest heroin policy.
This study found that Australian drug policy is based upon three policy pillars: demand reduction, supply reduction and harm reduction (Hamilton, 2001:97) (Ministerial Council on Drug Strategy, 2004)(Australian Institute of Criminology, 2012)(Australian Crime Commission, 2012). In the financial year of 2002-2003 Australia’s drug-related strategies was approximately $3.2 billion, with seventy-seven percent channeled to hierarchical strategies (Moore, 2008:408). The MSIC, however, an associative government initiative with the Public Health Association of Australia, numerous health and academic experts and the Uniting Church of Australia saved 3,000 overdose victims and helped 12,000 drug users while receiving about two hundred visits a day, which resulted in an eighty percent drop in overdose deaths in Kings Cross and built networks and trust with heroin users (Hamilton, 2001)(MSIC, 2012). Thus this study advises a mixed policy approach towards heroin policy, to contextually target the set areas using the most effective governance approaches to maximise success.
2.0 Introduction
Heroin is an illicit drug that the Australian government has been attempting to manage because of its addictive and hazardous attributes since the late 1960s. Unfortunately, the Australian approach is characterized by top down and to a lesser extent persuasive governance. This traditional hierarchical approach to heroin policy does not represent a state-centric relational government model, but rather a state-centric version that refuses to adapt to a changing climate. Top-down and persuasive governance does have an impact into drug based issues, however, solely relying upon or at least primarily relying upon a single model for all types of heroin policy, as with any type of policy, is irresponsible. Rather, contextual appropriateness needs to be taken into account to adequately and effectively address specific political policy issues. This case study analyzes the role of non-state actors and networks and the importance of different modes of governance in heroin policy making through the critical analyses and evaluation of Sydney’s Kings Cross Medically Supervised Injecting Centre (MSIC). It thus aims to demonstrate that top down and persuasive models in heroin policy making, are not the only or ideal variants of policy in this area and that other avenues need to be more heavily investigated and invested in by the Australia government.
3.0 Literature Review
Australia’s heroin policy is predominantly narrow in its focus on top down and persuasive governance methods as ideal solutions (Caulkins 2002:3). The academic literature surrounding Australia and other western liberal democracies’ approaches to heroin policy primarily suggests that that top down governance is often ineffective. Max Hopwood, Erica Southgate, Susan Kippax, Gabriele Bammer, Geetha Isaac-Toua and Margaret MacDonald (2003) argue that top down governance measures, such as partially banning injection equipment, often lead to poor acceptance by the affected parties resulting in the parties seeking ways around the ‘rules’ by taking actions such as reusing injection equipment, a potentially deadly act. Caulkin (2002:4), contrastingly, suggests that Australia’s preemptive approach through top down governance, strategic enforcement, disruption to supply and jail time for sellers has helped create the heroin drought. This has bought time and ultimately reduced and slowed the contagious effect of heroin. Caulkin does, however, note this top down approach only slows the spread. Anne Dray, Lorraine Mazerolle, Pascal Perez and Alison Ritter (2008) disagree on the effectiveness of the heroin drought’ as their study found macro-level disruptions to drug supply have a limited impact on street-level market dynamics when there is a ready replacement opioid such as morphine. Jonathan Henry Prunckun (2001) in an earlier study of top down governmental actions, concurs that there was no statistically significant increase in the price paid for heroin at street-level during 1988-1996 which saw increased domestic law enforcement attempts to uphold the heroin prohibition policy. Prunckun (2001), rather, suggests and supports with his findings that reducing demand at a local persuasive level would be more successful in upholding a heroin prohibition policy than actively attempting to stop heroin imports.
Persuasive governance, according to Peter Miller (2005), is more effective when combined with associative or community governance due to psychological constructs surrounding risk. He concludes that often risk behavior is functional and rational within the context of prohibitionist drug policy. Thus authoritative governance cannot defeat the psychological actions of risk but alternative forms can because risk is simply not involved.
Literature, comparatively, finds that most associative (both private interest government and corporatism), enacted governance has often been poorly metagoverned but have shown high acceptance from heroin consuming individuals, thus more willingness to take part in the programs. John Fitzgerald (2005) argues that through inefficient metagovernance associative governance can quite easily fail. His example is the “Tough on Drugs” policy which was an initiative brought about by John Howard in 1997 that resulted in a climate of distrust between associations and government, over-bureaucratization, slow decision making a resisted response from policy makers and a non-unified national drug policy. Effective metagovernance in heroin associative governance requires, “… supportive relationships with partner agencies… employing skilled staff and implementing consumer or participant input mechanisms…” according to Sarah MacLean (2012) who statistically associates these components with successful project implementation. Sonja Wälti, Daniel Kübler (2003) and David Moore (2004) argue that corporatism is highly effective in creating and enacting heroin policy, because it is more authentic and appears as a higher democratic quality (because it is less hierarchically enforced). David Moore (2004), further adds that corporatism with health groups brings medical and health expertise to policies, generally ensuring problems such as reusing injection equipment and a movement to alternative opioids do not occur.
Thus it is generally accepted from academics within the past ten years that: top down governance is ultimately ineffective; persuasive governance has helped convince heroin-affected parties of the negativity of heroin; and that associative governance has resulted in programs that have led to greater acceptance by heroin affected parties and which bring expertise such as health knowledge to an area which is more than just a criminal issue.
4.0 Methodology:
4.1 Main Argument:
Top-down and persuasive are the primary methods of governance implemented by Australia’s state-centric relational State and Federal governments in controlling the existence and use of the illicit drug heroin. Although the current tactics have been effective at characterizing heroin as a completely negative drug, the Australian government as a whole should not continue with these policies solely. Rather this form of governance should be used in combination with other varied forms of governance with appropriate metagovernance for superior results. This case study thus argues that associative governance should be currently prioritized in creating government heroin policy.
4.2 Key Questions:
To prove this argument this case study has examined the following key questions –
1. What policies have been successfully implemented and is there appropriate metagovernance behind them?
2. What policies have been unsuccessfully implemented and is there appropriate metagovernance behind them?
3. What associations are operating with, or available to the government?
4.3 Definition of subjects.
There are three types of subjects this case study explores, both successful and unsuccessful. Successful for this study is defined as governance cases that have been effectively metagoverned (as measured by the steering, effectiveness, resources, democratic-ness, accountability, and legitimacy) and have positively affected the ‘war’ on heroin use. Contrastingly, unsuccessful is the failure of effective metagovernance and results in negative or no impact on the ‘war’ on heroin use. These two types of subjects are also all confined within western liberal democracies with preference towards Australian for maximum acceptance by the governing bodies and for contextual appropriateness.
4.4 Strengths and Weaknesses.
This study’s obvious weakness is its focus on western liberal democracies and preferential treatment of Australian governance cases, which may not be the most effective in combating the illicit drug heroin and its focus upon top down, persuasive and associative governance; however, its strengths lie in its contextual appropriateness and potential acceptance by Australian policy makers.
5.0 Findings
The first easily accessible heroin was introduced to Australia in the 1960s by American soldiers stationed in Australia and since its introduction the number of heroin initiations has been growing exponentially (Appendix 2). Heroin as a problem thus first appeared in Kings Cross in Sydney, a hotspot for tourists and armed forces on leave (Hamilton, 2001:110). Heroin is an opioid that induces transcendent relaxation and intense euphoria but is also intensely addictive (Peterson, 1987:832). Common adverse effects include, contracting blood-borne pathogens such as HIV and hepatitis from sharing needles, contracting bacterial or fungal endocarditic and possibly venous sclerosis, abscesses, poisoning from contaminants added to dilute heroin, physical dependence resulting in withdrawal symptoms on cessation of use and decreased kidney function (Dettmeyer, 2005:19).
The first implementation of Australia’s current policy towards drugs was the National Campaign Against Drug Abuse which was founded on three policy pillars: demand reduction, supply reduction and harm reduction (Hamilton, 2001:97) (Ministerial Council on Drug Strategy, 2004). Regardless of the broad nature of these pillars, the Australian government focuses on top down and persuasive governance. This is not to say that Australia does not invest in associative, community or marketing governance but in comparison the amount is insignificant. Spending by Australian governments in financial year 2002–03 on all drug-related activities was estimated to be $3.2 billion. Proactive expenditure was estimated to be $1.3 billion, comprising fifty-five percent on enforcement, twenty-three percent on prevention, seventeen percent on treatment, thirteen percent on harm reduction and one percent on activities that span several of these functions. Expenditure on dealing with the consequences of drug use was estimated to be $1.9 billion, with the majority the result of crime-related consequences. (Moore, 2008:405).
These figures show that top down governance and persuasive modes of governance are the primary policies used by western-liberal democratic governments, however, the Australian government has partially followed other nations by developing an injection centre in Kings Cross in Sydney combined with support from the Public Health Association of Australia and experts during the New South Wales Drug Summit of 1999 (AIC, 2012) (ACC, 2012) (Hamilton, 2001:103). In the same year the Uniting Church of Australia was requested to operate the Sydney Medically Supervised Injecting Centre (MSIC) and in 2000 they accepted after the Sisters of Charity Health declined due to advice from the Vatican (MSIC, 2012). In 2010 the trial status of the MSIC was officially finished and legislation was enacted to ensure it remained. Numerous different agencies and organizations found that the MSIC is saving lives and reducing injury from drug overdose, reducing public injecting and the number of syringes discarded in public, is making contact with a vulnerable and hard-to-reach group of people who inject drugs and referring them into treatment services, and is reducing the risk of blood borne virus transmission. Dr Van Beek, who manages the centre said in an interview to the ABC that the centre has successfully managed more than 3,000 overdoses and helped 12,000 drug users while receiving about two hundred visits a day, similarly, the number of ambulance call-outs to overdose deaths in Kings Cross has dropped by eighty percent since the heroin drought compared to forty-five percent in the neighbouring suburb of Surry Hills where there is no centre (Sweet, 2010) (MSIC, 2012). In addition to meeting its aims, these evaluation reports have shown that the MSIC is cost effective, and is operating without adverse impact to the local community (MSIC, 2012)(Firestone, 2007:57)(Sweet, 2010)(. The MISC is an associative private-interest group form of governance that exemplifies the success this form of governance can have in heroin policy making.
6.0 Analysis
This case study has found that western-liberal democratic government policies on heroin are primarily separated into two sub-categories, which are defined by Jonathan Caulkins (2002), as mature market policy and emerging market policy (Appendix 1). A mature market such as the United States is a state that has gone through the contagious epidemic cycle (Caulkins 2002:3) that starts off at a few users which spreads via popularity to an epidemic of first time users, then drops to consumption primarily by long-term dependent users. An emerging market in contrast, is a state that is simply starting the ‘cycle’ (Caulkins, 2002:4). Australia is an emerging market that started the ‘cycle’ in the 1970s and now has the potential to turn into a mature market (Caulkins, 2002) (Hamilton, 2001:103) (Hughes, 2009:433) (Moore, 2004:1553). Thus Caulkins (2002) advises a mixed policy approach towards heroin in Australia’s emerging market (Appendix 1)(Caulkins, 2002:4), using top down enforcement (which is already approximately at seventy-seven percent (Moore, 2008:408) to slow the ‘cycle’ and associative initiatives to support and minimise numerically the eventual long-term dependent users.
The results from the MSIC’s trial and evaluations support the arguments made by Sonja Wälti, Daniel Kübler (2003) and David Moore (2004). The coordination with health experts and the Public Health Association of Australia has created an environment of expertise and legitimacy that has helped 12,000 heroin users (MSIC, 2012) (Robert, 2002:333). Margaret Hamilton (2001) explains that drug users find it extremely difficult to actively start rehabilitation programs because of the associated stigma of drugs and criminality. Thus the two-hundred regular visits per day represent the trust and networks effectively being created between the facility and the disconnected and disenchanted heroin affected individuals (Walti, 2003:499) (Robert, 2002:345)( Australian Heroin Diaries, 2011).
This program has obviously also been effectively metagoverned as can be seen by the organizations, location and expert reasoning behind the MSIC development. By directly associating with the Sisters of Charity Health then the Uniting Church of Australia, the MSIC was ‘marketed’ towards affected parties as an area of support rather than judgment (Robert, 2002:333). Correspondingly, by working with associations and experts the MSIC initiative was defined as democratic and legitimate.
7.0 Conclusions and Recommendations
7.1 Conclusion
The Australian government’s prioritization of top down and persuasive governance over associative or other forms of governance represents an argument made by ‘hollowed out state’ theorists, that governments are becoming weaker because they are not branching from hierarchical methods of governance. This statement may not be accurate all the time, but in regards to heroin policy in Australia, it is clear that the Australian government needs to utilise varied modes of governance in order to more effectively combat Australia’s unique emerging almost mature market heroin dilemma. Top down and persuasive governance undoubtedly has had an impact, but it takes more than a man with a big stick to eradicate an addiction.
7.2 Recommendations
This case study recommends the following actions to be taken into consideration:
1. A greater investigation and investment into associative governance to develop heroin policy.
2. Multiplication of the Medically Supervised Injecting Centre (MSIC) of Sydney in key heroin districts.
3. Continued focus on metagovernance to ensure heroin policy success.
4. Greater focus upon the first and third of the three policy pillars, demand reduction and harm reduction.
5. Greater investment in other than top down or persuasive governance. Although it should be noted that top down and persuasive governance may have higher initial and maintenance costs.
6. Further investigation into methods of network and trust creation between government and disconnected and disenchanted heroin affected individuals and groups.
8.0 References and Appendices
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Australian Crime Commission (2012). Crime Profile Series Fact Sheet: Heroin. ACC. Retrieved from: http://www.crimecommission.gov.au/publications/crime-profile-series-fact-sheet/heroin-0. Accessed 10/10/12.
Caulkins, J. (2002) Insights Australia Should and Should Not Take from US Drug Policy. Sydney Papers, The, 14, [1]. 1-10.
Dettmeyer, R B; Preuß, J; Wollersen, H; Madea, B. (2005). “Heroin-associated nephropathy”. Expert Opinion on Drug Safety 4 (1). 19–28
Dray, A. Mazerolle, L. Perez, P. Ritter, A. (2008). Policing Australia’s ‘heroin drought’: using an agent-based model to simulate alternative outcomes. Journal of Experimental Criminology. 4, [3]. 267-287.
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Hughes, C E. (2009). Capitalising upon political opportunities to reform drug policy: A case study into the development of the Australian “Tough on Drugs-Illicit Drug Diversion Initiative”, International Journal of Drug Policy, 20, [5], 431-437.
MacLean, S., Berends, L., Hunter, B., Roberts, B. and Mugavin, J. (2012), Factors that enable and hinder the implementation of projects in the alcohol and other drug field. Australian and New Zealand Journal of Public Health, 36: 61–68.
Miller P G. (2005).Scapegoating, self-confidence and risk comparison: The functionality of risk neutralisation and lay epidemiology by injecting drug users. The International journal on drug policy 1. 16, [4]. 246-253.
Moore, D. (2004). Governing street-based injecting drug users: a critique of heroin overdose prevention in Australia. Social Science & Medicine. 59, [7]. 1547-1557.
Moore, TJ.(2008). The size and mix of government spending on illicit drug policy in Australia. Drug Alcohol Rev. 27(4). 404-13.
Ministerial Council on Drug Strategy (2004). The National Drug Strategy: Australia’s integrated framework. Canberra: The Commonwealth of Australia .
MSIC. (2012). Sydney Medically Supervised Injecting Centre. Background and Evaluation. Retrieved from: http://www.sydneymsic.com/background-and-evaluation. Accessed on 10/10/12.
NSW Office of Drug Policy (2012). HEROIN: AN ASSESSMENT CURRENT SITUATION, TRENDS, AND POTENTIAL RISKS FOR AUSTRALIA AND NSW. Retrieved from: www.druginfo.nsw.gov.au/illicit_drugs/heroin/heroin.pdf. Accessed 10/10/12.
Peterson P, Sharp B; Gekker G, Brummitt C; Keane W (1987). “Opioid-mediated suppression of interferon-gamma production by cultured peripheral blood mononuclear cells”. J Clin Invest 3 (80): 824-831.
Prunckun H. (2001). Chasing the dragon: A quantitative analysis of Australia’s law enforcement approach to combating heroin trafficking, 1988 to 1996. UNIVERSITY OF SOUTH AUSTRALIA. 50-265.
Robert, S.B., Thomas, H.K., Jean-Paul, C.G. & Frederick, L.A. (2002). Safer injection facilities in North America: Their place in public policy and health initiatives. Journal of Drug Issues, vol. 32, no. 1, 329-355.
Sweet, M. (2010). About time…Sydney’s medically supervised injection centre gets the official nod. Crikey. Retrieved from: http://blogs.crikey.com.au/croakey/2010/09/15/about-time-sydneys-medically-supervised-injection-centre-gets-the-official-nod/. Accessed on 8/10/12.
The Australian Heroin Diaries (2011). Heroin Assisted Treatment. Retrieved from: http://theaustralianheroindiaries.blogspot.com.au/p/heroin-trial-supporter-list.html. Accessed 9/10/12.
Wälti, S. and Kübler, D. (2003). “New Governance” and Associative Pluralism: The Case of Drug Policy in Swiss Cities. Policy Studies Journal, 31: 499–525.