An Opportunity Missed |
The ‘winnable war on drugs: The impact of illicit drug use on families’ report tabled on the 13th of September in Australia’s Federal Parliament has created an unprecedented level of angst, anxiety and anger for many people working to address drug and alcohol problems, and for many people dealing with their own or family’s drug and alcohol problems. This paper is our response to the conduct of the inquiry, as well as each of 31 recommendations contained in the report: The Inquiry Terms of reference The Committee shall inquire into and report on how the Australian Government can better address the impact of the importation, production, sale, use and prevention of illicit drugs on families. The Committee is particularly interested in: 1. the financial, social and personal cost to families who have a member(s) using illicit drugs, including the impact of drug induced psychoses or other mental disorders; 2. the impact of harm minimisation programs on families; and 3. ways to strengthen families who are coping with a member(s) using illicit drugs. Commentary
The Recommendations Recommendation 1 The Commonwealth Government continue its allocation of significant resources to policing activity as a highly effective prevention method. (para 1.39) Response Partially Supported – Australia’s approach to drug use with allocation of resources to law enforcement, prevention, education, treatment and harm reduction programs has been both balanced and effective and deserves ongoing support. Recommendation 2 The National Health and Medical Research Council fund a long-term longitudinal study of the babies of drug-using mothers to look at the impact of maternal illicit drug use, including:
Response Partially Supported – the recommendation should include research on the impact of alcohol given the clear evidence that this adversely affects far more children and is the most common drug used. Recommendation 3 That the Minister for Health disallow the provision of takeaway methadone through the Pharmaceutical Benefits Scheme for drug users who are parents and have children living in their household. (para 3.55) Response Not Supported – this measure will be counter productive and is likely to provide a disincentive for parents wishing to undertake and maintain treatment. Establishing education and other safety protocols for parents on methadone programs would be far more beneficial and effective. Recommendation 4 The Department of Health and Ageing, as part of the next funding round for the Non Government Organisation Treatment Grants Program, give urgent priority to funding:
Response Partially Supported – there is support for funding for residential services to provide live-in facilities for parents (fathers and mothers) and their children, as well as providing more non-residential treatment options. However, proscribing organisations and requesting an explicit statement of a drug free aim to receive funding is unwarranted and demonstrates a lack of understanding on treatment outcomes. Engaging parents with drug problems into treatment is critical and this will require an understanding that achieving a drug free status will require a series of treatment goals to be set and achieved. Recommendation 5 The Commonwealth Minister for Families, Community Services and Indigenous Affairs, in conjunction with state and territory child protection ministers:
Response Not Supported – providing a stable and safe environment for children is supported but this measure is likely to be counter productive and instead provide a real and severe disincentive for any parents with drug use problems seeking treatment. Recommendation 6 The Minister for Families, Community Services and Indigenous Affairs include in the Legislative Instrument covering the implementation of the Income Management Provisions of the Social Security and Other Legislation Amendment (Welfare Payment Reform) Act 2007 requirements that:
Response Not Supported – developing systems and protocols that ensure child safety and care are supported but this measure will provide a disincentive for any parents with drug use problems to seek treatment. Recommendation 7 The Department of Health and Ageing, in liaison with state and territory governments, promote the integration of contraception and family planning advice into treatment and general practice services for drug using women of child-bearing age. (para 3.132) Response Partially Supported – this is a service that should be provided to all women and include information on alcohol and other licit drugs. Recommendation 8 The Commonwealth Government develop and bring to the Council of Australian Governments a national illicit drug policy that:
and
Response Not Supported – the current National Drug Strategy has achieved significant reductions in drug use and drug related harm. Harm minimisation includes a balanced and partnership approach between law enforcement, treatment, education, prevention and harm reduction services. Recommendation 9 The Department of Health and Ageing conduct research to estimate the full cost of pharmacotherapy programs to the Commonwealth, including the cost of medical consultations covered by Medicare. (para 4.94) Response Partially Supported – this research should be expanded to include all treatment not just pharmacotherapy programs. Recommendation 10 The Commonwealth Government:
Response Not Supported – the level, type and length of treatment should be based on clinical decisions between the treatment providers and the client. Methadone programs have been proven to be effective in reducing drug use and should not be restricted in use for ideological reasons. Recommendation 11 The Commonwealth Government list naltrexone implants on the Pharmaceutical Benefits Scheme for the treatment of opioid dependence. (para 4.118) Response Not supported – naltrexone implants have not been approved for use by the TGA and like all medications should undergo thorough clinical research and investigation prior to introduction widely. Recommendation 12 The Department of Health and Ageing:
Response Partially Supported – research should be available for the range of current and any new pharmacotherapy programs not just naltrexone implants and methadone. Any advisory committee established to oversee the research program must be made up of people with high level and relevant scientific and health expertise. Recommendation 13 The Australian Government Department of Health and Ageing undertake a review of needle and syringe exchange programs to assess whether they are:
Response Partially Supported – needle and syringe programs (NSP) have already been shown to be highly effective in reducing HIV, HCV and other viral infections and this is the ultimate goal of NSP. Gauging the level of community support for NSP and their referral of clients into treatment should be undertaken with a view to supporting and assisting NSP services to achieve these outcomes but not to the detriment of achieving their primary aim. Recommendation 14 Within the framework of the proposed illicit drug policy (see recommendation 8), the Commonwealth Government make a clear unequivocal statement, in line with the Prime Minister’s statement to the House of Representatives, that includes reference to:
Response Partially Supported – the effectiveness and benefits of such statements are unclear but if made should be done with reference to all drugs, illicit and licit, particularly given the damage imposed on families from licit drugs. Recommendation 15 The Commonwealth Government take a leadership role in reviewing and updating the National School Drug Education Strategy to re-iterate a commitment to a zero tolerance approach to illicit drugs and reflect the desire of parents for their children not to use illicit drugs. (para 5.31) Response Not Supported – the evidence is clear for comprehensive and holistic approaches to address drug and alcohol use in schools. A focus on the narrow rhetoric of zero tolerance will simply not address drug use in schools. Recommendation 16 While commending the Government on the media campaign against ice, the committee recommends that the Minister for Health and Ageing fund, as a matter of priority, a fourth phase of the National Drugs Campaign aimed at young people, that draws on experiences from the anti smoking campaign and other campaigns most notably the Montana Meth Project in the United States that:
Response Not Supported – all campaigns should be based and developed on well founded research and evidence that it reaches its intended target group(s). Recommendation 17 The Commonwealth Government provide funding only to organisations that adhere to the policy not to use language that glamorises or promotes the use of drugs, such as the terms ‘recreational’ and ‘party’ to describe drugs or drug use in public statements, correspondence and reports and that have implemented this policy to documents available electronically via their website. The Commonwealth Government also withdraw funding from organisations that promote legalisation of all or any illicit drugs. (para 5.84) Response Not Supported – there is a need for some agencies and services to actively engage with people using drugs and this will on occasions require the use of language that is relevant and appropriate to the target group. There is a need for ongoing review and debate on all aspects of drug and alcohol policy and funding should be based on merit not ideological positions. Recommendation 18 The Commonwealth Government:
Response Supported – although there is already in place a code developed by the Australian Press Council that meets this need. Recommendation 19 The Minister for Health and Ageing work with states and territories to implement bans on the sale of drug equipment and the Minister for Justice and Customs ban the import of such equipment. (para 5.94) Response Partially Supported – further investigation to assess the intended and unintended consequences of these policies is required prior to widespread adoption and expansion. All policies should be evidence based. Recommendation 20 The Commonwealth Government work with state and territory police to implement random testing for drivers affected by illicit drugs concurrently with random breath testing for alcohol. (para 5.109) Response Supported – there is strong evidence to support the benefits from random breath testing. Recommendation 21 As part of the next public hospital funding agreement between the Commonwealth and the states and territories, the Minister for Health and Ageing include a requirement for the implementation of a random workplace drug testing regime to improve safety for patients and other staff. (para 5.113) Response Partially Supported – further investigation to assess the intended and unintended consequences of these policies is required prior to widespread adoption and expansion. All policies should be evidence based. Recommendation 22 The Department of Health and Ageing include, as part of the next round of illicit drug treatment funding agreements, requirements that:
Further, the Department should maintain a database containing such information and make it public. (para 6.16) Response Partially Supported – collection of data on treatment outcomes is valuable. However, only focussing support for services demonstrating a drug free status is inappropriate and will result in many services working with complex and difficult issues not being funded. This recommendation also fails to recognise that relapse occurs and fails to define what criteria determine someone to be drug free. Recommendation 23 The Department of Health and Ageing, in conjunction with other appropriate agencies:
Response Partially Supported – providing simpler access to information on services for families is valuable but restricting the scope of information or advice that can be given on ideological grounds is inappropriate. Recommendation 24 The Australian Institute of Health and Welfare work with relevant government and non-government agencies to include in the Alcohol and Other Drug Treatment Services National Minimum Data Set measures relating to the use of family inclusive services to treat illicit drug use. (para 6.54) Response Supported – this would provide value data for decision makers. Recommendation 25 The Department of Health and Ageing promote, as part of the next round of funding arrangements for non-government drug treatment agencies, models of explicit informed consent for giving families information, which include a discussion about information management with all drug users on their initial consultation with health professionals. The Attorney-General, in consultation with state and territory governments and professional bodies, review whether the National Privacy Principles and Information Privacy Principles adequately allow for the position of families of clients with drug addictions, particularly with respect to sub-clause 2.4 and the definition of a client who is incapable of giving or communicating consent, and particularly where:
Response Partially Supported – further investigation to assess the intended and unintended consequences of these policies is required prior to widespread adoption and expansion. All policies should be evidence based. Recommendation 26 The Department of Health and Ageing, as part of the next funding round for the Non Government Organisation Treatment Grants Program give priority to funding services that help family members affected by a family member’s drug use. (para 6.85) Response Supported – provided services for families are evidence based Recommendation 27 The Minister for Health and Ageing, in conjunction with the states and territories, develop:
Response Supported – this could provide some valuable tools for practitioners. Recommendation 28 The Commonwealth Government:
Response Not Supported – whilst better policy responses are required in this area the evidence is clear that mandatory treatment is limited in application and value. Recommendation 29 The Department of Health and Ageing:
Response Supported – this would provide valuable information for decision makers and practitioners. Recommendation 30 That the Department of Health and Ageing, as the funder for the National Drug Strategy Household Survey, the Illicit Drug Reporting System and the Ecstasy and Related Drugs Initiative, require that data collected by collection agencies include:
Response Supported – collection of reliable data on the extent of this issue would be valuable. Recommendation 31 The committee notes the prevalence of illicit drug users developing mental illness, and therefore recommends that the Department of Health and Ageing oversee:
Response Partially Supported – more and better services for individuals and families dealing with drug use and mental health issues are supported, the restriction of these services to serve an ideological position is not supported. |