The NSW Drug Summit was triggered by the publication of a photograph in a Sydney tabloid newspaper of what was believed to be a twelve year old boy injecting heroin with equipment obtained from a needle syringe program. This provoked a furious debate about illicit drug policy. With only two months to a state election, the NSW Minister for Health acted swiftly, but perhaps unwisely. The needle syringe programme responsible was promptly suspended. Then it became known that the supposedly under age boy was really sixteen years old. It also later transpired that the needle syringe programme had fully complied with departmental policy. Some weeks later, Premier Carr announced publicly that, if his government was returned at the forthcoming elections, a drug summit would be held after the polls. This has had the effect, some might even say intended effect, of dampening down a frenetic public debate.

At the elections, Labor was returned with an enlarged majority. A Drug Summit was duly announced. As news filtered out about the arrangements, many reform minded commentators argued that the list of invited
participants was unbalanced. The 'family' contingent at that stage consisted only of zero tolerance supporters.

The NSW Drug Summit proved far more successful than most expected. The meticulous arrangements were completed within a few weeks and demonstrated the often derided public service at its very best. The Summit occupied a full week (May 17-21). It took place in the oldest parliament in Australia, involving all members of the new Parliament and another 70 invited delegates. On four days, there were plenary presentations in the morning
with working groups in the afternoon and early evening. On the third day of the Summit, all delegates had an opportunity to visit drug treatment centres. The key recommendations were debated on the afternoon and evening of the fourth day. The Summit was remarkable in many respects.

Inevitably, the few controversial recommendations were well reported. But many universally supported (but barely reported) recommendations will have far greater impact. Many politicians were shocked by what they saw in the drug treatment centres and subsequently referred to the "one third-two thirds" rule. This meant that at most drug treatment services, only one third of people seeking help can be accepted while two thirds are turned away because of lack of resources. Consequently, greatly increased funding for drug treatment attracted unanimous support. Even more remarkable, there was strong support for improving drug treatment in prison. Many of the
clinicians who have been around for a few years have heard such honeyed phrases many times before. This time the commitment is real and has strong bipartisan support. I well recall a (former) Commonwealth Minister for
Health telling me that "there are few votes in junkies and even fewer in prisoners". The case for increasing funding for drug treatment in the community and prisons is now so overwhelming, even on fiscal and crime control grounds -let alone public health -that there may even be some votes in funding for drug treatment in the community and prisons in the not too distant future.

Shylock argues in the Merchant of Venice 'when you prick me do I not bleed?' Another major outcome of the Summit was the astonishing discovery that drug users are, after all, also human beings. The need for a more compassionate approach to drug users was widely endorsed, although only grudgingly by some.

Another major area to benefit was prevention. Delegates heard a fascinating presentation by Professor Vimpani regarding the effectiveness of early interventions for troubled families. The case for taking prevention seriously has never been more cogently argued. Likewise, a more comprehensive approach to rehabilitation was strongly endorsed. There is, of course, more to drug treatment then drug treatment. But it needs money.

The almost 180 recommendations will now be considered by Cabinet. The fat lady will then sing in about 5 weeks. Although some of the more controversial recommendations may still be rejected by Cabinet, it seems
likely that most will be accepted. Some zero tolerance supporters were quick to decry the recommendations as covert legalisation. Yet many of the boldest recommendations have long been accepted elsewhere in Australia. The argument that the whole Summit was rigged for reform might have had more credence if zero tolerance supporters had raised this possibility before the recommendations they so bitterly opposed were accepted by a majority of delegates. Significantly, a recommendation to support a NSW heroin trial was narrowly defeated.

It is hard not to comment on the very different performance of the Government and the Opposition. There was also a striking difference in the performance of supporters of evidence based change compared to those
advocating retention of a morality based approach. The Premier's few interventions were striking and stylish. He began well by opening the Summit with a plea for open minds. Although the Leader of the Opposition responded well, the Leader of the National Party proudly announced that members of his party were not going to change their opinions just because of evidence presented at the Summit. The Government came across as disciplined and strategic. The Opposition case was often argued by an irascible and poorly informed National Party backbencher who would be a liability to any side of a debate. Many clinicians were heartened by the Opposition support for greater funding increases for treatment services than the Government was prepared to provide.

Was the whole event a carefully contrived set up as some claim? Or was the outcome largely a reflection of the far stronger case made for modest change? It may well be the case that polling available to the NSW Government before the election demonstrated strong public support for change. Announcing before the elections a Summit to be convened following the elections calmed the debate before the election and certainly gave the Premier an opportunity to demonstrate leadership by publicly changing position after hearing fresh evidence. But if this interpretation is to be taken seriously, it raises the question 'why did the Opposition not also change their position?' Is it conceivable that the NSW Opposition is too broke to afford opinion polls, too divided following their heavy loss to agree on change or their leadership too dependent on Prime Ministerial support for survival.

The establishment of a Tolerance Room at the Wayside Chapel before the Drug Summit altered the deliberations in a critical but hitherto unreported way. When leaders of the gay community saw public health advocates fighting all too familiar battles over discrimination and HIV control, they generously provided to drug users and their supporters consummate strategic skills, discipline and a sense of focus. If this new coalition is sustained, the future of advocacy involving drug use and public health in Australia will be changed forever.

Perhaps the most interesting and fruitful development of the Summit was the process itself. The combination of all involved parties - parliamentarians, drug users, families of drug users, lawyers, police, clinicians, researchers and government officials - talking to each other directly rather than through the media was time consuming and costly. But in the long run this process will be seen as an efficient and effective way of achieving progress with some of our most difficult to resolve social policy issues.

There can be no doubt that in some sense, the Drug Summit marks a watershed. NSW has now joined the conservative jurisdictions of Victoria and the ACT in recognising that illicit drugs is first and foremost a
health and social issue. Tasmania and South Australia seem to be heading in the same direction. The split, it should be remembered is within and not between the political parties. An increasing number now want to be part of the steam roller although some still obstinately want to be part of the road.

The five day Drug Summit may well in fact last 15 years. We will only know in five years if it has been successful. And then only if drug use, deaths, disease, crime and corruption have dropped.

Dr Alex Wodak
Director, Alcohol and Drug Service
St Vincent's Hospital Sydney
Tel: (+61) 02 9361 2439
Fax: (+61) 02 9361 2498
email: awodak@stvincents.com.au

(On Drugs This Week is a weekly commentary (usually written but sometimes
only edited) by David Crosbie, ADCA's Chief Executive Officer, that seeks
to promote discussion and debate of issues that may be important to the
Australian alcohol and other drugs field.)