Pubdate: Sun, 25 Jun 2000
Source: Jakarta Post (Indonesia)
Copyright: The Jakarta Post
Contact:  P.O. Box 85 Palmerah Jakarta 11001
Fax: (62) (21) 5492685
Website: http://www.thejakartapost.com
Author: Chris W. Green

PREVENT HARM IF WE CANNOT PREVENT USE

JAKARTA (JP): "This is a drug-free area." So shout the banners displayed in 
many communities in Jakarta and around Indonesia. Paradoxically, banners 
like this are most prominent in the areas where everyone knows that it 
isn't true, in places where drug use has already become an epidemic.

There can be few who are not aware that drugs are an increasing threat to 
the future of the nation, although not many are fully aware of the scale of 
the threat. Even less clear is how to respond to it. Other banners exhort 
us to "Just Say No" to drugs, even though many of us know how difficult it 
is to say no to that most legal of drugs, tobacco.

Of course, the easy answer is prohibition. Eliminate the supply of drugs. 
Would that it was that easy! Around the world, billions of dollars are 
spent trying to reduce the supply of drugs, with little or no impact on 
availability or price. Profits from supply of illegal drugs far exceed what 
law enforcement authorities can afford anywhere in the world, let alone in 
Indonesia. Here, these profits probably already exceed the combined budget 
of the police and the armed forces. Huge sums of money are available for 
traffickers to bribe their way out of problems.

Of course, we must try. But we must also be aware that our efforts are 
almost certainly doomed to failure. And we must therefore find alternative 
strategies.

The obvious choice is prevention. Encourage our children to say no to 
drugs. But this is also by no means easy, especially if we leave the 
problem to others. We cannot pass the responsibility to teachers or 
preachers -- rarely do they know much about drugs, and they spend only a 
very limited time with the children. In fact, research now shows that 
school-based drug programs are more likely to increase drug use, and at 
best make little difference.

Another mistake is to assume that our kids, being "good", will not be 
tempted. A combination of peer pressure and curiosity, both very prevalent 
among adolescents, will influence even the "best" children.

For prevention to be effective, it must start in the home, in the family, 
and start early -- by the time the children reach the age of nine or ten 
they are already becoming aware of drugs and beginning to ask questions -- 
usually to their peers who know no better than they do. Better they hear 
the right answers from us before that occurs.

Even the best parental guidance will have little impact upon those who are 
already addicted to drugs. Although patience and encouragement are crucial, 
success in curing addiction must start with a real commitment by the 
addict. Without this, relapse after treatment is almost inevitable.

Strangely to those of us who have never been under the influence of drugs 
and who only see the harm which addicts do to themselves, few are ready to 
make such a commitment. With all its problems, the world of addiction they 
live in seems better than reality -- and as we know, reality in Indonesia 
can be hard!

Sadly, few addicts are really aware or concerned about the harm they are 
doing to themselves. Few consider the threat of death through overdose or 
from AIDS or other conditions. The risk of these harms is greatest among 
drug users who inject. In particular, HIV, the virus which causes AIDS, is 
most efficiently spread through the sharing of needles -- once the virus 
has infected one member of a group sharing needles, the rest of the group 
can become infected within days. Experience around the world has shown that 
once more than 10 percent of injecting drug users (IDUs) in any community 
become infected by HIV, without extremely effective intervention that rate 
has usually exceeded 50 percent within a year.

There are signs that we are almost too late to prevent this happening in 
parts of Indonesia. Surveys have shown HIV rates already as high as 20 
percent among IDUs in Jakarta. Extremely urgent action is needed to address 
this. We are too late to prevent these people using drugs; we cannot expect 
quick success in attempting to stop most of them using drugs. What we must 
do quickly is to reduce the harmful effects, including the spread of HIV. 
Again, experience around the world has shown that there are really only two 
responses that are effective -- and these can be very effective, if 
controversial. The first is to try to encourage IDUs to stop injecting, 
usually by providing alternatives such as methadone, a cheap liquid drug 
that is taken orally. For those not ready to change to methadone, providing 
easy, cheap access to clean needles is really the only solution.

Neither of these approaches is ideal. But both work. Both will help ensure 
that when users are finally ready to make the commitment to stop using 
drugs (as most do sooner or later), they will still be healthy and able to 
play a productive role in society.

As we consider our options and look for solutions on the International Day 
against Drug Abuse and Illicit Trafficking on June 26, let us not ignore 
the large number of our young people who will not be reached by strident 
prevention messages. If these are to survive, they need our support to 
avoid the harmful effects of their drug use.
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MAP posted-by: Keith Brilhart