Australia's 2007 National Drug Strategy Household Survey, in which more than 23,000 people over the age of 12 were quizzed by the Australian Institute of Health and Welfare about their drug use and attitudes toward various drug policy positions, has demonstrated broad support for medical marijuana and harm reduction measures aimed at hard drug users.

Regarding heroin use, the survey found that 67% supported needle exchange programs, 68% supported methadone maintenance, 75% supported the use of naltrexone for overdose avoidance, and 79% supported the use of rapid detox therapy. On the other hand, only 50% supported heroin injection sites, and only 33% supported heroin maintenance therapy.

Medical marijuana also won strong support. Some 69% supported legal medical marijuana, while an even larger number, 75%, supported clinical trials for medical marijuana. In all the policy choices cited here, support was at higher levels than the most recent national survey in 2004.

Marijuana legalization for personal use did not fare so well. Only 21% supported legalization, down from 27% in 2004. The intervening period has been one of Reefer Madness Down Under, with Australian authorities and a complicit media waxing hysterical about the alleged dangers of the weed.

When it comes to legalizing other drugs, support was in the single digits, and relatively unchanged from 2004.

Frighteningly, large majorities of Australians favored increased criminal penalties for drug sales offenses. More than 80% favored harsher sentences for hard drug sales, while even for marijuana, nearly two-thirds (63%) wanted stiffer penalties.

The US Congress Joint Economic Committee yesterday held a historic hearing on the economic costs of US drug policy. The hearing, titled Illegal Drugs: Economic Impact, Societal Costs, Policy Responses, was called at the request of Sen. Jim Webb (D-VA), who in his opening remarks described the all-too-familiar failure of US drug policy to accomplish the goals it has set for itself. It was the second hearing related to incarceration that Webb has convened under the auspices of this committee.

"Our insatiable demand for drugs" drives the drug trade, Webb pointed out. "We're spending enormous amounts of money to interdict drug shipments, but supplies remain consistent. Some 86% of high schoolers report easy access to marijuana. Cocaine prices have fallen by about 80% since the 1980s," the freshman senator continued. "Efforts to curb illegal drug use have relied heavily on enforcement. The number of people in custody on drug charges has increased 13-fold in the past 25 years, yet the flow of drugs remains undiminished. Drug convictions and collateral punishments are devastating our minority communities," Webb said.

"Our current policy mix is not working the way we want it to," Webb declared. "The ease with which drugs can be obtained, the price, the number of people using drugs, the violence on the border all show that. We need to rethink our responses to the health effects, the economic impacts, the effect on crime. We need to rethink our approach to the supply and demand of drugs."

Such sentiments coming from a sitting senator in the US in 2008 are bold if not remarkable, and it's not the first time that Webb has uttered such words:

In March of last year, he told George Stephanopoulos on the ABC News program This Week: "One of the issues which never comes up in campaigns but it's an issue that's tearing this country apart is this whole notion of our criminal justice system, how many people are in our criminal justice system more -- I think we have two million people incarcerated in this country right now and that's an issue that's going to take two or three years to try to get to the bottom of and that's where I want to put my energy."

In his recently-released book, A Time to Fight, Webb wrote: "The time has come to stop locking up people for mere possession and use of marijuana," "It makes far more sense to take the money that would be saved by such a policy and use it for enforcement of gang-related activities" and "Either we are home to the most evil population on earth, or we are locking up a lot of people who really don't need to be in jail, for actions that other countries seem to handle in more constructive ways."

Still, drug reformers may be impatient with the level of rethinking presented at the hearing. While witnesses including University of Maryland criminologist Peter Reuter, author of "Drug War Heresies," and John Walsh, director of the Washington Office on Latin America (WOLA) offered strong and familiar critiques of various aspects of US drug policy, neither of the words "prohibition" or "legalization" were ever uttered, nor were the words "tax and regulate," and radical alternatives to current policy were barely touched upon. Instead, the emphasis seemed to be on adjusting the "mix" of spending on law enforcement versus treatment and prevention.

The other two witnesses at the hearing, Kings County (Brooklyn), New York, Assistant District Attorney Anne Swern and community coordinator Norma Fernandes of the same office, were there to talk up the success of drug court-style programs in their community.

[The written testimony of all four witnesses is available at the hearing web site linked above.]

"US drug policy is comprehensive, but unbalanced," said Reuter. "As much as 75% of spending goes to enforcement, mainly to lock up low-level drug dealers. Treatment is not very available. The US has a larger drug problem than other Western countries, and the policy measures to confront it have met with little success," he told the committee.

Reuter said there were some indications policymakers and the electorate are tiring of the drug war approach, citing California's treatment-not-jail Proposition 36, but there was little indication Congress was interested in serious analysis of programs and policies.

"Congress has been content to accept rhetoric instead of research," Reuter said, citing its lack of reaction to the Office of National Drug Control Policy's refusal to release a now three-year-old report on drug use levels during the Bush administration. "It's hardly a secret that ONDCP has failed to publish that report, but Congress has not bothered to do anything," he complained. "We need more emphasis on the analytic base for policy."

But even with the paltry evidence available to work with, Reuter was able to summarize a bottom line: "The US imprisons too many people and provides too little treatment," he said. "We need more than marginal changes."

"US drug policies have been in place for some time without much change except for intensification," said WOLA's Walsh, noting that coca production levels are as high as they were 20 years ago. "Since 1981, we have spent about $800 billion on drug control, and $600 billion of that on supply reduction. We need a stiff dose of historical reality as we contemplate what to do now," he told the committee.

With the basic policies in place for so long, some conclusions can now be drawn, Walsh said. "First, the balloon effect is real and fully relevant today. We've seen it time and time again, not just with crops, but also with drug smuggling routes. If we want to talk about actually reducing illicit crops and we know eradication only leads to renewed planting, we need to be looking for alternatives," he said.

"Second, there is continuing strong availability of illicit drugs and a long-term trend toward falling prices," Walsh said, strongly suggesting that interdiction was a failed policy. "The perennial goal is to drive up prices, but prices have fallen sharply. There is evidence of disruptions in the US cocaine market last year, but whether that endures is an open question and quite doubtful given the historical record," he said.

"Third, finding drugs coming across the border is like finding a needle in a haystack, or more like finding lots of needles in lots of different moving haystacks," he said. "Our legal commerce with Mexico is so huge that to think we can seal the borders is delusional."

With respect to the anti-drug assistance package for Mexico currently being debated in Congress, Walsh had a warning: "Even with US assistance, any reduction in the flow of drugs from Mexico is unlikely." Instead, Walsh said, lawmakers should adjust their supply-control objectives and expectations to bring them in line with that reality.

Changes in drug producing countries will require sustained efforts to increase alternative livelihoods. That in turn will require patience and a turn away from "the quick fix mentality that hasn't fixed anything," Walsh said.

"We can't expect sudden improvements; there is no silver bullet," Walsh concluded. "We need to switch to harm reduction approaches and recognize drugs and drug use as perennial problems that can't be eliminated, but can be managed better. We need to minimize not only the harms associated with drug use, but also those related to policies meant to control drugs."

"It is important to be able to discuss the realities of the situation, it's not always a comfortable thing to talk about," Webb said after the oral testimony. "This is very much a demand problem. I've been skeptical bout drug eradication programs; they just don't work when you're supplying such an enormous thirst on this end. We have to find ways to address demand other than locking up more people. We have created an incredible underground economic apparatus and we have to think hard about how to address it."

"The way in which we focused attention on the supply side has been very much mistaken," agreed Rep. Maurice Hinchey (D-NY), who along with Rep. Bobby Scott (D-VA) and Sen. Amy Klobuchar (D-MN) were the only other solons attending the hearing. "All this focus on supply hasn't really done anything of any value. The real issue is demand, and prevention and dealing with people getting out of prison is the way to deal with this."

Reuter suggested part of the solution was in increase in what he called "coerced abstinence," or forced drug treatment. Citing the work of UCLA drug policy researcher Mark Kleiman, Reuter said that regimes of frequent testing with modest sanctions imposed immediately and with certainty can result "in a real decline in drug taking and criminal activity."

That got a nod of agreement from prosecutor Swern. "How long you stay in treatment is the best predictor of staying out of trouble or off drugs," she said. Swern is running a program with deferring sentencing, with some flexibility she said. "The beauty of our program is it allows us to give people many chances. If they fail in treatment and want to try again, we do that," she said.

As the hearing drew to an end, Webb had one last question: "Justice Department statistics show that of all drug arrests in 2005, 42.6% were for marijuana offenses. What about the energy expended arresting people for marijuana?" he asked, implicitly begging for someone to respond, "It's a waste of resources."

But no one connected directly with the floating softball. "The vast majority of those arrests are for simple possession," said Reuter. "In Maryland, essentially no one is sentenced to jail for marijuana possession, although about a third spend time in jail pre-trial. It's not as bad as it looks," he said sanguinely.

"There's violence around marijuana trafficking in Brooklyn," responded prosecutor Swern.

WOLA's Walsh came closest to a strong answer. "Your question goes to setting priorities," he said. "We need to discriminate among types of illicit drugs. Which do the most harm and deserve the most emphasis? Also, given the sheer number of marijuana users, what kind of dent can you make even with many more arrests?"

And so ended the first joint congressional hearing to challenge the dogmas of the drug war. For reformers that attended, there were generally thumbs up for Webb and the committee, mixed with a bit of disappointment that the hearings only went so far.

"It was extraordinary," said Sanho Tree, director of the Drug Policy Project at the DC-based Institute for Policy Studies. "They didn't cover some of the things I hoped they would, but I have to give them props for addressing the issue at all."

"Webb was looking for someone to say what he wanted to say with the marijuana question, that perhaps we should deemphasize law enforcement on that," said Doug McVay, policy analyst at Common Sense for Drug Policy, who also attended the hearing. "I don't think our witnesses quite caught what he was aiming for, an answer that arresting all those people for marijuana takes away resources that could be used to fight real crime."

Sen. Webb came in for special praise from Tree. "Perhaps because he's a possible vice presidential candidate, he had to tone things down a bit, but he is clearly not afraid to talk about over-incarceration, and using the Joint Economic Committee instead of Judiciary or Foreign Affairs is a brilliant use of that committee, because this is, after all, a policy with enormous economic consequences," Tree said. "Webb is clearly motivated by doing something about the high levels of incarceration. He held a hearing on it last year, and got the obvious answer that much of it is related to drug policy. Having heard that kind of answer, most politicians would walk away fast, but not Webb, so I have to give him credit."

Reversing the drug war juggernaut will not be easy. The Congressional Joint Economic Committee hearing Thursday was perhaps a small step toward that end, but it is a step in the right direction.

Every day for 15 months, Vancouver heroin addict Rob Scott Vincent, 36, went into a nondescript building on the city's Downtown Eastside where a nurse would hand him a syringe loaded with pharmaceutical grade heroin. Sitting at a sterile, stainless steel counter, Vincent would inject himself with the drug, then sit in an equally sterile waiting room for awhile as the drug took hold before heading out to do his daily business.

Vincent was one of 251 participants -- 192 in Vancouver and the rest in Montreal -- in the only heroin maintenance program in the hemisphere, a pilot program known as the North American Opiate Maintenance Initiative (NAOMI). Originally intended to operate in both Canada and the US, the US component never got off the ground in the drug war atmosphere there. And now, NAOMI is winding down in Vancouver and Montreal. The last handful of participants in the program will get their last fixes at the end of this month.

In the program, which was limited to long-time addicts over 25 who had failed to kick the habit at least twice in previous treatment tries, participants used treatments of oral methadone or injected heroin. A small percentage received a pharmaceutical opiate called Dilaudid. Participants also received counseling and other support services. The Canadian federal government (then under control of the Liberals) funded the project with $1.8 million and agreed to allow the importation of pharmaceutical heroin for the project.

Similar pilot opiate maintenance projects in Switzerland, Germany and the Netherlands produced results showing reductions in criminality, drug use, and economic costs to society, and increases in health, stability, and employability among participants. NAOMI researchers and supporters are hoping it will produce similar results. While the final research report from NAOMI is not expected until the fall, preliminary results suggest the findings will be similar to those in Europe.

In a March briefing paper, NAOMI reported that 85% of participants taking injected heroin had stayed with the program for 12 months, that the treatment had proven to be "extremely safe," and that there had been no security issues or evidence that NAOMI had had a deleterious impact on the neighborhood. The paper also suggested that the program would show a positive economic impact.

Canada estimates that each heroin addict costs the country $45,000 a year. The studies of European opiate maintenance programs report that they save host countries $20,000 a year for each participant.

"What we know now is that we were able to recruit people with long-term dependence on heroin who repeatedly failed other treatments and who had many health and social problems when they entered," said Dr. David Marsh, one of the co-investigators and lead clinical physician for the study. "From a doctor's perspective, whether they were treated with methadone or heroin, many of them improved dramatically. We'll know from the formal research results how much and in what ways they improved."

The provision of methadone or heroin was only part of the treatment, Marsh said. "The medication is a component of a broader package of primary care, mental health care, addiction counseling, and case management to provide participants with access to a range of welfare and other benefits," said Marsh. "We work with people to try to manage the negative consequences of their drug use and help them improve their lives."

Vincent had been addicted to opiates for nearly 15 years when he decided to participate in NAOMI. "I wanted to see if it could better my life, and it did," he said. "It helped me slowly wean down. I'm still using, but not even one-third of what I was using."

Vincent's stint in NAOMI ended in March. Since then, he has had to return to the streets to find his drugs. "It's not too bad," he said. "I mostly use morphine pills, and I pick up a pill for $5 bucks every morning and I'm good for the day." Vincent pays for his fixes by collecting and recycling cans. But sometimes, he can't find what he wants and has to spend time searching for a substitute opiate -- heroin, dilaudid, whatever is around. "It's usually readily available," he said, "but sometimes I have to scrounge around."

Getting participants completely off opiates wasn't the be-all and end-all of the pilot program, said Marsh. "Patients benefit in a lot of ways," he said. "Some were able to stop taking illegal opiates, and in my view, if a patient is prescribed methadone and is using it properly, I consider that a success. Methadone treatment has been available for many years, and there are thousands of studies showing its benefits."

The Vancouver Area Network of Drug Users (VANDU) was one of the key supporters of NAOMI, despite its complaints about the restrictiveness of the standards for qualifying for the study. The program needs to continue, VANDU said.

"Regardless of the parameters they set that made it tough to qualify, this is a badly needed service and it's a shame it's just a pilot project and is not continuing," said VANDU president Richard Utendale. "I've talked to a lot of people who have been helped by it. They were able to improve their day-to-day lives by not having to struggle to feed their drug habits. NAOMI provided a safe place and support, and participants didn't have to worry about being jacked up by the police or ripped off or sold inferior products or dope with adulterants."

The Downtown Eastside, where both VANDU and NAOMI are located is the epicenter of one of the largest hard drug scenes in the hemisphere. The program had an impact on the area, said Utendale. "I think NAOMI also improved the neighborhood, with less street and property crime."

There was a downside to NAOMI, though, said Utendale. "The drawback is that when people are finished with the program, they have to go back on the street and resort to the same old means of getting their drugs. That's why this needs to be permanent."

Vincent said he wished the program could continue. "I would most definitely participate in a permanent program," he said. "It was very, very helpful. It's a lot easier to quit or reduce my intake with pharmaceutical grade heroin. Most of the stuff on the street is cut with other things -- that's why I like to use morphine. I can't see any reason for not keeping this open," he said. "NAOMI is a medical facility, just like Insite [the Vancouver safe injection site]. They should not shut it down."

But that is what is going to happen at the end of this month. Last November, doctors appealed on compassionate grounds to extend the program on behalf of five participants. So far there has been no agreement from either Health Canada or the regional health authority.

"Dreams are free," Utendale sighed, "but the way things are looking right now, this isn't going forward without some changes in Ottawa."

Marsh said it was "premature" to try to predict what would happen. "But I'm optimistic we'll find funding and get the regulatory approval at some point to apply the lessons we've learned from this study," he said.

But given the current Conservative federal government's ideological opposition to harm reduction, as evidenced by its losing battle to shut down Vancouver's safe injection site, it is going to take a new national election before there is any chance that Canada will follow the Europeans' lead and make heroin maintenance part of a broader public health policy.

The Vietnamese National Assembly is considering legislation that would make drug use an administrative violation -- not a crime. Under current Vietnamese law, drug use is a criminal offense, a violation of Article 199 of the country's criminal code, and is punishable by up two years in prison.

But Truong Thi Mai, chair of the Assembly's Committee on Social Affairs, told a press conference last Friday the committee had recommended scrapping Article 199. "Being addicted to or using drugs should be considered a disease, and should only be subject to administrative fines," Mai said. "We cannot jail hundreds of thousands of drug users, can we?"

In actuality, Vietnam does not typically jail drug users; instead, it confines them in mandatory drug detoxification centers for up to two years, or in some centers, up to five years. Local governments maintain lists of drug addicts in their areas and send them to detox centers at their discretion. Few drug users are actually prosecuted under Article 199, so the impact of a decriminalization move would be mostly symbolic.

Still, that would be a good thing, said Le Minh Loan, a police chief and former director of counter-drug efforts in a province with one of the country's highest heroin addiction rates. "I think it makes sense to drop the article," Loan said. "Few countries in the world sentence drug addicts to prison terms."

Vietnamese drug rehabilitation efforts are not particularly effective, Loan said. "The rate of relapse into drug use is very high."

While Vietnam has harsh laws for drug dealing -- 85 people were sentenced to death last year for drug offenses and nine more so far this year -- those laws have had little impact on drug use in the Southeast Asian nation. Harsh enforcement is not working, said Mai. "Many people have been sentenced to death for trafficking heroin, but heroin trafficking is still rampant," Mai said. "The traffickers know that the laws are strict but they are still trafficking narcotics."