Promoting Illicit Drug Prevention Initiatives Nationally

Promoting Illicit Drug Prevention Initiatives Nationally

Drug Free Australia is pleased to offer the following comment on the Draft National Drug Strategy 2010-2015. This document provides feedback developed initially in February 2010, with updates up to December 2010.

Addressing Emerging Issues and New Developments

1. Cross Sectoral Approaches

How can structures and processes under the National Drug Strategy (NDS) more effectively engage with sectors outside health, law enforcement and education? Which sectors will be particularly important for the NDS to engage with?

Drug Free Australia’s findings:

Models of integrated services in other countries are now, and have previously, proven to be successful in establishing a person-centred approach to recovery from drug addiction.

Increasingly the growing trend of the abuse of pharmaceutical drugs means that there should be closer links with the Pharmacy Guild and specialists in allied areas, to ensure coordinated responses can be made.

Governments need to raise awareness among their constituents, (especially focusing on young people) to the health consequences of prescription drug abuse. It is equally important for NGOs in allied health fields and pharmaceutical associations to cooperate fully with regulatory agencies, to enforce professional codes of conduct, and to take action against members who engage in unethical, dangerous or unlawful practices.

In addition, doctors who prescribe drugs should be given training that familiarizes them with the latest schemes used by drug dependent/addicted people to obtain prescription drugs through fraudulent means. Patient education is also essential for maintaining a secure and closed system of distribution for prescription drugs. Many legitimate patients do not understand the difference between controlled substances and other prescribed medicines and, as a result, may not know that that providing a controlled substance to another person can be unlawful, dangerous and unwise.

The following are examples whereby effective linkages and partnerships between law enforcement, health, education, community services, welfare, housing, local governments, non-government organizations and academia will go a long way to achieve better outcomes for people in recovery.

Example 1: Sweden

For over 30 years an integrated approach to drug control has been taken in Sweden. In recent times this has been based on the ‘Swedish Action Plan on Narcotic Drugs – 2006-2010’.The Plan’s cornerstone is based on a partnership between government and community, with the common goal of a ‘Drug Free Sweden’.

In summary:

Sweden, a previously drug-liberal country with the highest European drug use levels, now has the lowest levels of drug use amongst OECD countries. Sweden’s restrictive drug policy, puts a heavy emphasis on prevention of drug use, with a minimal harm minimization program. It has the support of 95% of its citizens.

Restrictive policy vs Zero Tolerance

A ‘restrictive’ policy is more comprehensive than simply ‘zero tolerance’ which tends to push people into jails and drive drug use even further underground. The main components of a restrictive policy are:

• Planning and development of coordinated policies and inter-sectoral cooperation between government (politicians, public servants) education (community, schools an tertiary), law enforcement (police and customs), health workers, (agencies for early intervention, treatment and rehabilitation).
• Regular review of policy decisions and frameworks when implemented
• Progressively increasing drug control measures via acts of parliament – with a vision of a ‘drug free’ society. (Please refer to ‘Sweden’s successful drug policy – a review of the evidence’, page 17)
• A level of ‘coercive care’ in drug treatment.
• Greater emphasis on prevention measures such as early intervention, education, supply reduction
• Greater consideration of if, and how, harm reduction processes might be implemented, with comprehensive community consultation, prior to implementation and during the review processes. (For example, a law to allow needle exchange programs was passed in 2006 – under certain conditions – that they be endorsed by the local community and that they proactively motivate drug users to seek treatment. Regulations to be reviewed to ensure these two requirements are rigorously adhered to.

Example 2: United States of America

In the United States the current Administration has focused on one such program via the Office of National Drug Control Policy. The following is an extract from the ONDCP website:

“The aim of the new recovery-oriented agenda is to help people live a substance-free life of good health, nurturing relationships, self-sufficiency, and hope for a productive future. This policy, in keeping with the 2005 National Summit on Recovery, recognizes recovery as a process of change through which an individual achieves abstinence from substance abuse, along with improved health, wellness, and quality of life”.
Further -
“By transforming systems and fostering partnerships, these projects bring together a wide range of services that help people in recovery build and maintain a substance-free lifestyle. Typical recovery support services include housing, medical and dental care, mental health treatment, employment training and placement, family counselling, peer support/mutual aid support networks, child care, and transportation.

ONDCP will continue to promote the idea that recovery is possible. This focus on recovery will provide the Nation with a new lens through which to view addiction, as well as new policies that will sustain renewed health and wellness for those striving to remain drug free”. For further information go to:

For current policy projections in the United States, a copy of the National Drug Control Strategy 2010 can be located at:

Example 3 – United Kingdom - Integrated Drug Treatment Services (IDTS) in prisons

Given the high rates of drug use and recidivism amongst offenders in Australia, there is much that could be improved in our prisons to ensure those who are drug dependent are given every opportunity to become drug free. One measure that DFA would not support, is that of providing needles and syringes to prisoners while incarcerated – as we contend that this would not be helpful to their achieving recovery from drug addiction.

In the United Kingdom, the IDTS program offers much in terms of a concept for integrated services. “The objective of ‘IDTS’ is to expand the quantity and quality of drug treatment within HM Prisons by:

• Increasing the range of treatment options available to those in prison, notably substitute prescribing
• Integrating clinical and psychological treatment in prison into one system that works to the standards of Models of Care and the Treatment Effectiveness Strategy and works to one care plan
• Integrating prison and community treatment to prevent damaging interruptions either on reception into custody or on release back home.

The IDTS has to work closely with the DIP programme in particular to ensure that offenders receive seamless support and are retained in treatment after release. There is a central project team comprising Prison Service, Prison Health, Care Services Improvement Partnership and National Treatment Agency that has the task of managing the first wave roll out of 49 prisons (approximately a third of prisons in England)”. For further information go to:

1. Indigenous Australia

• Where should efforts be focused in reducing substance use and associated harms in Indigenous communities?
• How could Aboriginal and Torres Strait Islander people’s needs be better addressed through the main National Drug Strategy Framework?
• In that context, would a separate National Drug Strategy Aboriginal and Torres Strait Islander Complementary Action Plan continue to have value?

Drug Free Australia’s findings:

DFA has consulted widely with indigenous people, particularly in the Northern Territory and has compiled a report on these consultations. The findings are a direct response from the indigenous people in several regions of the Northern Territory and we recommend to you a model for rehabilitation and recovery which originated from discussions which have been ongoing since 2008.

Please refer to Attachment 1, “Updated Analysis of the Northern Territory Emergency Response” – (Compiled by Drug Free Australia, July 2008 - Updated April 2009).

1. Capacity Building

• Where should effort on the support and development of drug and alcohol sector workforce be focused over the coming five years?
• Where should efforts be focused over the coming five years to increase the capacity of the generalist health workforce to identify and respond to substance use problems?

Drug Free Australia’s findings:

Over the next five years, there needs to be more focus placed on prevention and early intervention, with the drug and alcohol sector working in partnership with youth organizations, schools and tertiary institutions. The training of drug and alcohol workers should complement that of Youth Workers, with greater resourcing made available to enable teachers, GP’s, social workers and counselors to intervene early if they identify potential alcohol and drug use amongst their youth cohorts. There should also be more resourcing for range of treatment facilities which have a clear goal of recovery-based rehabilitation.

1. New Technologies

• What are the particular opportunities and challenges that technology development is likely to pose for the community and the alcohol and drug sector over the next five years?

Drug Free Australia’s findings:

The benefits of new technologies for the drug and alcohol sector could be to utilize networks established for integrated service provision. The sharing of information and data collection can be improved and generated more widely and with greater transparency, while at the same time, ensuring confidentiality and privacy.

An area of growing concern is, however, the purchasing of pharmaceutical drugs on the internet and this needs to be addressed quickly, via international links at governmental level and national via Customs and the Federal Police.

1. Increased Vulnerability

• How can efforts under the NDS better complement the social inclusion agenda such as addressing unemployment, homelessness, mental illness and social disadvantage.
• Where should effort be focused in reducing substance use and associated harms among vulnerable populations?

Drug Free Australia’s findings:

Using ideas and concepts from successful integrated services models used internationally, the new NDS will be able to demonstrate greater social inclusion.

Effort in reducing substance use and associated harms amongst vulnerable populations needs to be done with a clear prevention focus in place. The new NDS needs to demonstrate that there is the Political Will in this country to turn the statistics around, just as was done in Sweden several decades ago.

Please refer to two publications as supporting evidence for this statement:

(See pages 11 and 12)

(note ‘Long Term Drug Use Trends’)

1. Performance measures

• Are publicly available performance measures against the NDS desirable?
• If so, what measures would give a high level indication of progress under the NDS?

Drug Free Australia’s findings:

Drug Free Australia supports the notion of using key performance measures within the Draft NDS. However, it is recommended that these be taken a step further, so that they are measurable Key Performance Indicators (KPI’s). This will enable greater integrity with outcomes and can then be supported with independent evaluations to give more robust results.

It is noted on page 35 of the Draft NDS that ‘comprehensive national data are not available on all these measures’ and that this may be overcome by the preparation of ‘an annual report on data against these measure for inclusion in the annual report of the Intergovernmental Committee on Drugs’.

However, there are three valid reasons for the rationale of including at least some measurable KPI’s in the new NDS:

1. More credibility with positive national/international scrutiny of Australia’s effort in its NDS

Evaluators of the National Drug Strategy have, for sometime, recognized that within the Federal system (and its multiple stakeholders) the governance of Australian drug policy is a challenge – often critiqued for the lack of transparency of decision-making and inconsistent use of its evidence-base. For these reasons and, given the current wide range of sources for relevant data available in Australia, measurable KPI’s could be developed, using current benchmarks.

1. Technological capability

In times of technological advancement and relative ease of gathering accurate, up to date statistical information, this is an opportunity to follow similar initiatives in the United States regarding improvement of data collection, and consider making it a key objective in the new NDS - (ONDCP’s– National Drug Control Strategy 2010, Chapter 7)

1. Greater flexibility to move with changing trends

A further benefit is that, based on normal planning practice, interim reviews would not only be easier to conduct, but would have greater integrity, asmeasurable KPI’s could be assessed mid-term to determine progress towards targets/trends. At this point, modification to policy and practice could be made if, and when, deemed necessary.

While the wide consultation process being used in the development of the NDS 2010-2015 is most commendable, it is recommended that more lead time be planned, prior to the next Strategy’s consultation process – (i.e. prior to 2015)so that the NDS 2016 could be ready to proceed in a timely way, thus avoiding a gap year.

By way of example of two drug strategies that use measurable KPI’s please refer to:

for an example of KPI’s established in the Drug Strategy of Ireland.

In addition, the Office of National Drug Control Policy (ONDCP) in the United States offers a further example with measured goals in the “National Drug Control Strategy 2010” (on page 6) at:

Addressing Priorities for Action during the next 5 years

Drug Free Australia sees the following as top priorities for the new NDS:

Reflecting the Political Will of the current Federal Government’s policy platform to ensure that the following are addressed, resourced and implemented:

• Primary prevention – that is prevention of initial uptake of illicit drugs
• Early intervention – to ensure that, where substance abuse is detected there are strategies and support in place to successfully address the issues
• Treatment – giving top priority to assisting people to become drug free. This includes a complete review of, and more accountability for, Needle and Syringe Programs throughout Australia.

International research into the effectiveness of such programs has been carried out – Please refer to Attachment 2 “The Effectiveness of Needle Exchange Programs” by Dr. Kerstin Kall (research is also attached in power-point slide presentation)

For further information please contact:

Josephine Baxter

Executive Officer

Drug Free Australia

1 Collingrove Avenue

Broadview, SA 5083

m: 0403 334 002

email:

Attachments:

1. “Updated Analysis of the Northern Territory Emergency Response” – (Compiled by Drug Free Australia, July 2008 - Updated April 2009).

1. “The Effectiveness of Needle Exchange Programs” by –Kerstin Käll, MD, PhD, University of Linköping, Sweden, (with research also attached in power-point slide presentation).

Drug Free Australia Ltd, National Office:1 Collingrove Avenue, Broadview, SA 5083 Email: Web: Patron: Dr Margaret Court