Winning the war on the war on drugs

ON 12 NOVEMBER 1986, physician Alex Wodak and his staff fixed a note to the door of their building near to St Vincent’s Hospital in Darlinghurst, Sydney: ‘If you would like a clean needle and syringe, free, press this buzzer.’

Providing needles and syringes to drug-users was illegal. The Netherlands had introduced needle exchange to prevent HIV infection two years earlier with promising results, but in Australia police and politicians argued against it, claiming it sent the wrong message and would increase drug use – arguments now familiar in the pill-testing debate.

Alex had written thirteen separate submissions to the NSW Department of Health requesting permission to run a pilot needle-exchange program, but knew he wouldn’t get permission any time soon. So he called his staff together.

‘The time to act is now,’ he said. ‘We have a chance to save lives; to prevent misery, suffering and death. I’m asking you to help.’

He warned that they could be charged with aiding and abetting drug use. But breaking the law was a last resort in a critical situation. Alex laid twenty dollars on the table and asked where the hospital’s diabetes unit sourced their needles and syringes. The staff also threw in money. They bought one thousand from a wholesaler.

They were nervous and excited. They didn’t know who would come. Maybe it’d just be the police. They waited.

ALEX WODAK IS ready to talk: ‘Okay,’ he says. ‘Let’s do this!’

We’re in his home in Darlinghurst to talk about his thirty years as a physician, researcher and advocate for drug law reform. I’m interested in his experiences of dealing with prohibition and how it punishes the marginalised. ; in the ways those who strive for a better world do their work – and what remains to be done. But to explain how his Let’s do this sounds – as he stands from the kitchen table, rinses his breakfast bowl and sits in the chair adjacent – I need to take you back ten minutes.

I’ve walked up Oxford Street this clear Sydney morning, turned at the sandstone wall of the old Darlinghurst Gaol, passed Green Park and St Vincent’s Hospital into to a tucked-away block of flats on the edge of Kings Cross. Standing at the ground-floor intercom, I’m preparing to meet the man who worked with others to defy authorities and introduce needle exchange before it was legal during the 1980s HIV/AIDS epidemic; who was part of a group who used civil disobedience to operate a medically supervised injecting room in the 1990s; who served as director of the Alcohol and Drug Service at St Vincent’s Hospital for thirty years and continues as emeritus consulting physician; who responded to John Howard’s attacks on these programs by telling the Australian public their Prime Minister didn’t understand science or evidence; who is greeted with applause and cheers by his supporters, and is jeered by supporters of the war on drugs. (Miranda Devine once called him ‘Australia’s pre-eminent pusher’.)

Standing outside the locked foyer, I imagine him as earnest, permanently frowning; someone who values efficiency. And my nervousness is compounded because the intercom speaker is so soft I’ve missed his first few sentences of directions, rendering the rest of the instructions obsolete. He finishes, and the buzzer for the lock sounds.

I stare at the intercom, half-swallowing my words: ‘The sound is too soft, I couldn’t hear…’

‘Pardon?’ he says.

‘Can you say it again?’ I ask.

He repeats the instructions, loudly, precisely, emphasising each word. He has planned for us to spend seven hours together today.

But as he ushers me into his apartment, he explains that he had to take his car to the mechanic this morning and hasn’t had breakfast. He’ll be with me soon. I sit on the couch and Alex sits down to breakfast at the kitchen table. It’s a modest apartment and we’re just a few metres apart. I’m looking at the courtyard while Alex faces the bookshelves opposite. We’re looking past each other, and neither of us says a word.

Part of my interest in Alex is understanding what drives him and why the core of his work has involved fighting for measures to improve the lives of the disadvantaged. These seem important questions at a time when authoritarianism, tribalism and scapegoating are on the rise: Trump called for the return of the death penalty for drug dealers, and the death toll in Duterte’s murderous war on drugs in the Philippines is now calculated as somewhere between 6,600 and 27,000.[i] Here in Australia, the federal government has recently pursued punitive laws to drug-test Newstart recipients, quarantine their payments and force them into treatment programs.

I’d call myself a bleeding heart, and I wonder if that’s what Alex is too – or is his outlook more abstract, driven by pragmatism and support for the most effective policies? When I’ve heard him talk in the media, he hammers home the evidence until contrary positions look absurd, revealing the ideology and moralising that lie behind many arguments for prohibition. If I faced that sort of opposition, I’d get worn down – people’s lives are at stake here.

This is what I’m thinking about as we sit in silence and Alex eats his breakfast.

When he announces Let’s do this he may even clap, and I begin to see instead a man with a highly ordered and logical mind. Perhaps his is a mind so logical he is impervious to the personal attacks, the opposition, the delays and bad arguments. Perhaps he can compartmentalise so effectively these become irrelevant.

He presses his hands onto his knees, almost nervously, and we begin. He’s uncomfortable with my focus on him because all his work ‘has been carried out in partnerships’. He has a close-shaven professorial beard and a high brow, and prefaces our conversation with a caution on the matter of his privilege – his status as a white, male doctor in a prestigious hospital. ‘A female community nurse would have a much tougher time than me,’ he says. ‘I was conscious of it at the time, and conscious of it now.’

IN JULY 1982, Alex started as director of the new Alcohol & Drug Service at St Vincent’s Hospital, Sydney. Three months later, two of his colleagues diagnosed the first case of AIDS in Australia (HIV had not been discovered and named at that stage). The epidemic would have a profound influence on Alex’s career. From 1983–85, HIV infections rose from a handful of cases to around 4,500 in the inner suburbs of Sydney and Melbourne. Kings Cross and its surrounding suburbs had Australia’s largest concentration of men who have sex with men, sex workers and people who inject drugs – those most at risk of infection.

This location – with the hospital at its heart – has shaped both Alex’s career and Australia’s take on harm reduction. A policy of harm reduction contends that society should find ways to prevent potential negative consequences of drug use, treat it as a health issue and help users rather than punishing them. Most of the city’s gay bars, brothels, street workers and drug markets were within walking distance of Alex’s workplace. St Vincent’s had a tradition of caring for the marginalised, the homeless, those with alcohol and drug dependence.

In March 1985, the ABC’s Four Corners aired an episode devoted to AIDS, which featured a young journalist, Russell Hanley, who was being treated for AIDS-related lymphatic cancer at St Vincent’s. He lay propped on the bed, his neck thin and his face drawn, throwing his nose and ears out of proportion. The interviewer asked, ‘Are you going to pull through?’

‘Yes,’ he said, his voice thin. ‘I don’t see why not.’

The camera cut to his hand, clasping his partner’s, their knuckles white. His partner looked like he’d come from work, in a gingham shirt and tie, and he tried to smile. But his eyes darted with worry. Three weeks later Four Corners reported that Hanley had become the twenty-fifth Australian to die with AIDS.

To some commentators, the people at risk of AIDS were ‘poofters, junkies and whores’. Fred Nile, the Christian leader and member of the NSW upper house, declared AIDS was a ‘wrath-of-God disease’. Nile and other conservative commentators called for a mass blood-testing program for every Australian and quarantine for those who tested positive to HIV. In Learning to Trust (UNSW Press, 2003), Paul Sendziuk detailed the everyday reactionary discrimination that followed: gay men were evicted from homes and denied accommodation; NSW police halted random breath-testing, fearing contact with saliva; plumbers refused to work on pipes at restaurants where gay men might have eaten or worked.

However, rather than let fear, stigma and the unknowns of HIV/AIDS defeat them, LGBTQI activists intensified their efforts. Grassroots organisations of the gay rights movement demanded improved medical services, ran education programs about HIV, and developed a response to the crisis in a partnership with the federal government and health professionals. It brought them into mainstream political structures.

‘The commitment, dedication, hard work – and ruthlessness – of the gay community was something to behold,’ said Alex. ‘I knew we needed something like that for people who inject drugs.’

IN THE MID-1970s, Julie Bates was working as a law clerk for a Melbourne firm that represented people who used drugs as well as drug sellers, sex workers and brothel owners. It was the time of the Beach Inquiry into police corruption in Victoria, and one of her jobs was to take statements to be presented to the inquiry. Julie grew up in the 1950s and had been raised to believe that the police were there to protect people, and were honest and trustworthy. Now she was hearing people ‘talking about having drugs and guns planted in their homes, even in the bedrooms of their children’.

Her beliefs turned upside down, she moved to Sydney in the early 1980s, joining activists in the sex-worker rights movement; she became a sex worker herself. Through her network of friends and colleagues, Julie and her partner Alan Winchester saw the inequities in the way people who used drugs were treated in clinical settings, particularly in pharmacotherapy.

‘It was a punitive model, treating adults like children, watching people piss into cups and kicking them off the program if they’d used an illicit substance.’

As the spread of HIV and the practice of punitive treatment converged, Julie and Alan began challenging the system at a local methadone program in Darlinghurst. Which was how they met Alex.

Alex was co-managing a fledgling methadone program at St Vincent’s and was looking for someone who understood the community. With the help of a gay rights activist, he called a community meeting to try to build a sense of common purpose among people who used drugs. Julie came, as well other sex workers, gay men and health workers. About half of the thirty who turned up were people who injected drugs. The name ADIC was suggested: AIDS Drugs Information Collective.

Alex had read a short paragraph in The Lancet about needle exchange, and thought: ‘Of course that’s what we need to do.’ The members of ADIC agreed, and their advocacy began. After evasion and delays from the NSW Department of Health, Alex and his staff had pinned their notice to the door.

‘It was a nightmare,’ says Alex, recalling that time. ‘I couldn’t sleep.’

But while Alex and his staff ran the needle exchange from their Darlinghurst building, Julie and her network began distributing needles from the Australian Prostitutes Collective office in Brougham Street. Some volunteered to go out on the streets after hours; some passed clean needles and syringes to sellers who could supply their customers directly. They had to be more covert than Alex, who’d discovered media attention and controversy was useful for getting the word out. Their status left them vulnerable.

Alex may have been risking his career, but he also knew he didn’t face the same dangers as people using drugs – or as anyone who was marginalised and persecuted. His position at an ecclesiastical public hospital also provided some protection – the Minister for Health couldn’t sack him without the agreement of the chairman of the hospital board and the head of the congregation of nuns. The minister, however, could direct the police to Alex, and soon he received a call that he was required to present to a police station to be interviewed.

At the station, four detectives sat across from Alex with their arms crossed. But Alex was prepared. Terrified they might shut down the needle exchange, he had been obsessively gathering evidence of its success.

‘I was very wound up,’ he says.

He launched into a lecture, speaking non-stop for forty-five minutes on what the medical community knew about HIV/AIDS, citing pages of epidemiological facts and figures, what his unit had learned about people who inject drugs, outlining what was happening in Geneva, Milan, New Jersey and New York City.

‘This is a public health emergency,’ he finished. ‘It’s crazy we haven’t started this earlier.’

The detectives said that the minister had insisted they interview him, but they would not charge him. They even wished him luck.

‘I knew then we’d won,’ he says.

SOON AFTER, NSW legalised the supply of needles and syringes, the other states followed suit, and the Australian Pharmacy Guild agreed its members would sell needles and syringes. Australia now has more than 800 needle-exchange locations and distributes more than thirty million needles and syringes annually. An estimated 4,590 lives had been saved by 2010.[ii] Australia has one of the lowest rates of AIDS in the world, whereas rates in the US, which took a punitive, zero-tolerance approach, are ten times higher.

In 1989, Alex secured government funding to establish a peer-led organisation for people who use drugs. The board hired Julie as its first manager, recognising her experience in community building with her work at the Australian Prostitutes Collective, and she moved the fledgling organisation out of Alex’s offices and into a disused brothel above what was the Bourbon and Beefsteak Hotel. The state government rejected the organisation’s first name, National Users and Advocacy Association, telling them they couldn’t advocate for rights. They switched the word ‘advocacy’ for ‘AIDS’, and ADIC became NUAA. Now one of the largest government-funded organisations for drug users in the world, it runs a methadone program out of its centre, provides harm reduction services and peer-network education, advocates for better services and treatment, and advises government.

Alex won’t be drawn about the personal costs of pushing for reform. He says – in a cursory manner – that he’s been named by ministers in the media, abused and spat on in the street. ‘It got to me at first,’ he says. ‘I learned to develop a thick skin.’

He was more preoccupied with why anyone should have to ‘go through purgatory’ to get needle exchange when there was significant evidence supporting its efficacy. A year after the exchange began in Sydney, he toured Europe and the US to see how other countries were responding to HIV/AIDS. The pioneering activist Yolanda Serrano took him to a shooting gallery in Williamsburg, Brooklyn. Half the buildings in the street were burnt out, cars were up on blocks, tuberculosis was rife, municipal services had run out of money – this was the dystopia of Reagan’s austerity. There was no electricity, so Alex held a lit candle as he entered a tenement and walked downstairs to a room where two men and two women were injecting speedballs – a mix of heroin and cocaine. In the midst of the HIV/AIDS epidemic, here they were, sharing needles. Yolanda handed out cotton wool and bleach because providing needles was illegal. Alex could see blood dripping from previous puncture sites.

‘I think to myself, this is a catastrophe,’ says Alex. ‘These people are irrational, what a waste of space these guys are, I need to talk to them.’

There’s a hardness in these sentences, which I’ve never heard before, in the way Alex speaks about vulnerable people. But this is young Alex, learning about the world. In that Williamsburg basement, he tried to talk to the people injecting drugs about the danger of AIDS; he was told to ‘shut the fuck up’.

By the end of that evening with Yolanda he’d completely changed his view.

‘I saw how society had abandoned these people,’ says Alex – that the police harassed them, that they had no home or property or job, that they were hungry most days, that they ‘had no future’. Earlier Alex had told me his parents were Moravian Jews who fled Europe and then Singapore when he was a child, and I wonder if this experience made him mindful of how life can change in an instant due to circumstances beyond your control. He realised that for many, the relief provided by drugs in the short-term outweighed any risk – of AIDS, of dying early. In this, he afforded the men and women in the shooting gallery rationality in their decision-making. He realised the impact of social factors on drug use, and that the war on drugs was a war on people. He realised that prohibition and punishing marginalised people was the real cause of harm.

‘I knew then I’d spend the rest of my life pursuing drug law reform.’

IT’S CLOSE TO nine at night and I’m walking the Cross with Will Tregoning. He points to a café and says he ‘lost count’ of the number of times he met with Alex there. Will had sought advice on creating a new drug law reform organisation aimed at mobilising younger people, in the way the environmental movement had active and diverse participants. Later Alex and Will worked together in a coalition of researchers and health organisations to fight the federal government’s 2017 proposal to drug-test welfare recipients, writing submissions to two inquiries, meeting with senators and working with GetUp! to draw popular attention to the issue – with Alex as one of the key public experts in the campaign. Their campaign proved to be a success.

Will grew up in Neutral Bay and attended an elite Catholic school where he witnessed the way many in the wealthy and middle classes regularly consumed illicit drugs while rarely becoming the subject of public discussion. ‘We know from research that the demographic most likely to have consumed drugs in the past year are tertiary educated with stable employment,’ he explains as we walk towards Club 77 on William Street.

From his North Shore childhood home, he used to look across the water towards the Cross and yearn for the vibrant nightlife. When he finished school in 1997, he started frequenting Club 77, dancing ‘with sweat dripping off me with everyone else feeling the same – pleasure, acceptance, celebration. I felt a transformative sense of participation in something incredible. Then I’d go home and talk with friends until dawn.’

The first time I saw Will he was coming out publicly – and awkwardly – as a person who used drugs on an SBS segment on drug law reform. Tall and wiry with upswept blonde hair, he talks more easily now about his experiences, pausing occasionally to compose his sentences, drawing together connections as he goes.

‘Ecstasy made me a better person,’ he says.

Fridays at 77 were queer nights, and Will heard that MDMA had helped many in the community deal with the trauma of the 1980s AIDS epidemic. This confirmed his own transformative experience, exciting him about research into therapeutic drug use.

It also left him pondering why cultural narratives of drug use focused on substance abuse and dependence, stories of people spiralling out of control, lives destroyed. Sometime later, he met journalist Lisa Pryor, whose 2011 Small Book About Drugs (Allen & Unwin) examined the costs of prohibition and its discriminatory application: middle-class people who use drugs are relatively safe and hidden, whereas the disadvantaged are exposed and vulnerable and over-policed. Lisa condemned the silence of the majority of drug users, who had the financial and social capital to push for change. It reflected the ‘political engagement of my generation’, she wrote, ‘our preference for managing risk individually rather than fighting for change on a political level’. Lisa introduced Will to Alex, and in 2014 Will and Lisa founded the advocacy organisation Unharm.

‘I’m interested in a positive vision for drug law reform,’ says Will. ‘Not just critiquing the war on drugs and how destructive it is, but talking more about the benefits of drug use, and how for most people it’s a normal experience… It’s a reorientation, to think about how drugs can improve your life, rather than only framing it in terms of a problem.’

There’s been a recent resurgence of research into the therapeutic benefits of MDMA, ketamine and psychedelics such as psilocybin mushrooms, including at prestigious universities and hospitals. In the US, Johns Hopkins Medicine recently launched their new US$17 million Center for Psychedelic & Consciousness Research, and St Vincent’s Hospital in Melbourne is trialling psychedelic drugs to treat severe depression in the terminally ill. Research has demonstrated therapeutic benefits for everything from major depressive illnesses and anxiety to anorexia nervosa, Alzheimer’s disease, and opioid and alcohol dependence.

The results of MDMA-assisted therapy for sufferers of PTSD have been remarkable: more than two thirds of participants were in remission at the twelve-month follow-up in one study, twice the success rate of the next best treatment.[iii] In the US in 2016, the Food and Drug Administration gave MDMA ‘breakthrough’ status and allowed Phase III clinical trials, the last step before approval as a prescription drug.

‘The war on drugs has stalled the potential of these substances for decades,’ says Will.

The dominant cultural representations of drug use, focused on a minority experience of dependence, debt and crime, shapes the belief that vulnerable people are to blame for their circumstances. This allows policy-makers to target individuals rather than addressing ‘the structural inequality in which the vulnerabilities to addiction can flourish’, argued Paul Hayes, a leading UK drug policy analyst, in The Conversation.[iv] Instead of improving access to housing, education, jobs and treatment for trauma and depression, we punish people for their disadvantage. Some commentators argue that the US has become a ‘carceral state’ as a result of its war on drugs. It has 5 per cent of the world’s population, but 25 per cent of its prisoners. Among Australian prisoners, drug offences are the second most common category.

Although narratives around drug use are now changing, Will still sees ‘music festivals and pill testing [as] a privilege-related story… It’s such a thin slice of the problems.’ But the high-profile debate around music festivals has prompted bureaucracies to consider new approaches and reforms on drug policies. The NSW Coroner’s inquiry into deaths at music festivals, and the separate Special Commission of Inquiry into the Drug ‘Ice’ (neither of which have been released at the time of writing), are expected to recommend harm reduction measures such as pill testing, more drug consumption rooms, reduced use of police sniffer dogs and decriminalisation of illicit drugs for personal use. NSW Labor opposition leader Jodi McKay declared support for a trial of pill testing if the final coronial report recommended it. Perhaps as more middle-class drug use becomes part of public conversation, more people will speak out about their drug use. This, Will hopes, will help reduce the stigma for everyone. In any case, acts of civil disobedience, Alex points out to me in a later email, wouldn’t work for pill testing: the equipment is so expensive that no one could risk having it confiscated. ‘It’s a tactic best used rarely,’ he writes.

ALL DRUG USE comes with a certain degree of risk. One popular psychoactive recreational drug is neurotoxic, mutagenic (causes genetic damage), carcinogenic even in small doses, hepatotoxic, physically addictive and associated with developmental delay, cognitive impairment, fertility problems, poor memory, aggression, depression, anxiety, psychosis, hallucinations and sleep disorders: alcohol. One study published in The Lancet developed an index of the harm caused by different drugs, in terms of costs to individuals and society, adjusted for scales of use. Alcohol was the most harmful, above heroin, methamphetamine and cocaine. MDMA and psychedelics were the least harmful. The paper says ‘drug classification systems have little relation to the evidence of harm’. Despite alcohol causing the most harm, it’s illicit drugs that are most often associated with ‘unduly negative images’ and fear.[v]

In a meeting room where the couch holds cushions that have ‘HIV+’ printed in bold type, Leah McLeod, formerly Alex’s PA and research assistant at St Vincent’s and now the publications co-ordinator at NUAA, is describing the consequences of stigma and the risks that prohibition creates for people who use illicit drugs.

NUAA has received accounts of women losing custody of their children when their past drug use is brought up in family court disputes, and of others denied treatment at hospitals even for conditions unrelated to drug use, such as a bone fracture. One woman who’d taken methamphetamine sought help from an emergency department and was locked in a cupboard for twenty-four hours. Stigma is the negative view that one group of society holds towards another; it affects self-esteem, can damage relationships, leads to discrimination, and prevents people from seeking and accessing treatment.

‘Some things you only understand if you’re a user,’ says Leah. ‘Stigma can be internalised, so you feel worthless yourself.’

She has pale blue eyes, a kind face and a serious tone. Leah’s primary-aged daughter had a schoolfriend whose parents stopped all contact between the children when they found out where Leah worked. Her experience of stigma has led her to support a human rights model of drug law reform. She is even wary of the lauded Portuguese model, which permits ‘functioning’ drug use but sends people to treatment if they have ‘dysfunctional’ use. ‘If people want to inject every day they should be allowed,’ she says. ‘I’d like to be able to buy home-brand heroin at the supermarket.’

Early in 2019, Leah’s husband went to hospital following a heart attack. Staff continually introduced her husband as someone ‘with a history of drug abuse’. His condition deteriorated over the following weeks: he slurred his words, woke in the night, fell out of the hospital bed. Finally Leah took him to their GP, who diagnosed him with a brain tumour. Three weeks later he died. His odd behaviour ‘wasn’t caused by methadone but a brain tumour’, says Leah. ‘But they had made up their mind he was a junkie.’

That’s the difference with Alex, she says. ‘Throughout his career he made decisions with his patients based on evidence and objective clinical assessments – not on what he thought about people… He put himself on the line because he believed in the science.’

Leah shares impressive details about Alex’s career that he’s downplayed, including his work advising other nations on harm reduction – including Egypt, Afghanistan, Pakistan, China and throughout South-East Asia. ‘He helped get fundamentalist countries to run methadone programs,’ says Leah. ‘Even needle exchange in prisons. We don’t have that here yet.’

Alex would come back from meeting politicians and bureaucrats and tell Leah which of his arguments had proven persuasive and which hadn’t. He taught her how to frame arguments about drug law reform and harm minimisation until Leah was confident enough to run workshops for doctors and other groups herself. Eventually they co-authored peer-reviewed papers on harm reduction among people who inject drugs.

‘He was mentoring and shaping me the whole time,’ says Leah.

She remembers one conversation with two men in the street, one of whom had been on ‘some pretty fine gear’ in Asia. Back in Australia, he became incredibly unwell and sought treatment. The man said the doctor who treated him was smart enough – and compassionate enough – to put him on opiates and gradually bring him down, rather than move him straight to substitutes or symptom relief. He finished by saying, ‘that man saved my life’.

‘I realised he was talking about Alex,’ says Leah.

WHEN MATT NOFFS – co-founder of the Street Universities and CEO of the Noffs Foundation – first saw Alex at a conference, he thought, ‘If this is the person who thinks more deeply about drugs than anyone else, then I want to know how he thinks.’ It took a while to get Alex’s attention, but when he did, Alex gave Matt ‘more than anyone ever had’.

Matt hails from a family that have dedicated themselves to working with disadvantaged people, especially the homeless and young people with serious substance dependencies. He’s written books on methamphetamine and addiction, and was one of the leaders of the successful campaign for pill testing that led to the ACT authorising a trial at the Groovin the Moo music festival. He’s studied Alex’s career intently.

Matt talks of people joking – affectionately – that Alex went too far with proposals for drug law reform. ‘I agreed,’ he says. ‘However strong the evidence, I didn’t think the public would ever accept regulation because of narratives of fear around drug use.’

What made sense, he thought, was to push for more conservative harm-reduction measures such as pill testing; many in the field thought that had a better chance of being approved. Yet Matt and I were talking just days after the ACT had legalised cannabis for personal use. And the ACT’s actions, along with suggestions it would consider legalising MDMA, had emboldened Matt to adopt Alex’s position – something he wouldn’t have considered a year before.

‘It shows the message is getting through,’ says Matt. ‘Alex was ahead of us.’ It was back in 1996 that Alex wrote a short book with Ron Owens calling for the decriminalisation and regulated sale of cannabis and MDMA, and for heroin to be available on prescription for those who were dependent.

For Alex, for Matt, for many working in this field, the unregulated black market is what creates most of the risk associated with illicit drug use. Talking with Alex at his apartment, he’d described prohibition as one of three failed and destructive twentieth-century ideologies – the other two, fascism and communism, had collapsed, and prohibition would too, he said. ‘It could happen rapidly,’ he warned. ‘It’s prudent we prepare and get the policies right, so we don’t make the same mistakes we made with alcohol.’

A FEW DAYS after my day with Alex I go to Green Park, wedged between St Vincent’s and the old Darlinghurst Gaol wall, to think about everything I’ve heard. The breadth of my conversation with Alex – which ranged from the Opium Wars of the nineteenth century to US foreign policy to George Pell’s threat to strip property from the Sisters of Charity when they offered to manage a medically supervised injecting centre – amounted to far more than I can mention here.

I think of the team of collaborators he’s been assembling across the decades, people who work with him, people who want to take his work further. I think of Alex speaking – as he did over the intercom – patiently and firmly, repeating his arguments over and over again. Drug prohibition could be described as form of slow violence – a catastrophe that plays out over long timescales, and largely out of view. This story is an attempt to humanise a field that largely tells its stories through the lens of evidence.

The poet Kenneth Slessor, nostalgic for his Kings Cross of the 1930s, said the Cross was a term rather than a place – its boundaries flexible, more a ‘state of mind’. When I lived in Sydney in the 2000s, the Cross had scents of jasmine and frangipani, stale beer, urine and perfume, and every now and then a hit of sea breeze rushing up the hill. It was a place of derelict industrial lots and terraces repurposed as cafés with strappy leaved plants spilling onto the footpaths, souped-up and meticulously cared-for cars, and all of it overseen by a garish Coca-Cola sign.

Even then, ‘the strip’ was a parody of itself. But the Cross was still an idea, a state of mind. It was a place of organised crime, corrupt police, exploitation, inequality and violence – but it was also a place to find likeminded people, to escape judgment. Which is what makes the story of reform here so extraordinary – vulnerable people who gathered together to seek acceptance ended up working together for survival, liberation and change. Harm minimisation was shaped by a crisis that ultimately engendered credibility and resolve. From those beginnings, it continues to grow.

By the end of my day with Alex I knew I’d misinterpreted his breakfast silence. It was more than a logical, task-driven mind adhering to routine – he was working to ensure he could give his full, undivided attention to me, as an act of respect towards someone he didn’t know. Here was a person who had dedicated himself to a field, to reform, to saving and improving lives with rigorous attention for thirty years – whose Okay, let’s do this sounds like a phrase he’s been using, and acting on, all his life.

Alex learnt to work with what he had, recognising the strength of his position and the authority of being a physician at a prestigious hospital. He used that to full effect, intensified it for the benefit of individuals and a wider cause. In a recent article for The Saturday Paper, Luke Buckmaster described the climate change activists of Extinction Rebellion as a group that encourages white, middle-class people – who can choose to be arrested – to ‘weaponise’ their privilege.[vi] It’s a fitting phrase for what Alex Wodak has been doing all these years.

But where I saw Alex as pragmatic, Matt Noffs sees an idealist. ‘He’s asking us to dream of a better world,’ he says. When someone tweeted the suggestion that Australia wouldn’t have had needle exchange without him, Alex’s reply was spare – ‘not true’ – before he suggested someone else would have done it if he hadn’t. Maybe, but maybe too late, as in the US or in France, where so many lives were lost.

‘He’s the one who did it,’ Leah said to me. ‘He took the personal risks because he knew he had to champion what was right. Not just once or twice, but over and over and over for years and years, with people deriding him and hassling him.’

I see tears well in her eyes. ‘You can’t fucking say that for a lot of people, man.’

Read in Griffith Review 67: Matters of Trust.