When the Victorian Parliament’s Law Reform, Road and Community Safety Committee commenced its Inquiry into Illicit and Synthetic Drugs and Prescription Medication all the way back in November 2015 expectations were high. Committee member and key driver of the inquiry, Reason Party leader Fiona Patten, has described it is “probably the most comprehensive inquiry into drug policy ever in Australia”.
This was an opportunity to conduct a wide-ranging examination into Victoria’s laws, procedures and regulations relating to illicit and synthetic drugs as well as the misuse of legal pharmaceutical drugs.
The question the committee was asking was a simple one – were these laws, procedures and regulations minimising drug-related health, social and economic harm or making things worse?
To get to the heart of what was working and what could be done differently, the committee decided to look at the practice of others states and territories as well as overseas jurisdictions like Portugal. No stone would go unturned in determining what Victoria’s approach to alcohol and other drugs should look like.
The inquiry was exhaustive. The committee received 231 submissions from experts and stakeholders including peak bodies, the alcohol and other drug treatment sector and legal professionals. There were nine days of public hearings in Melbourne and Sydney and the committee travelled to Geneva, Lisbon, London, Vancouver, Sacramento and Wellington to speak to experts at the forefront of drug policy and law reform.
When the 680-page report was finally released in March this year it didn’t disappoint. There are 50 recommendations providing a comprehensive road map for reforming Victoria’s approach to prevention, law enforcement, treatment and harm reduction. The report recommends what many experts have long been advocating – treating all drug offences for personal use and possession as a health issue, not a criminal justice issue. It also features plenty of headline-grabbing suggestions including calls for pill testing at music festivals and changes to drug-driving laws as well as exploring alternative models for drug offences including Portugal’s much publicised decriminalisation model.
But what did the report have to say about people who inject drugs, the state of Victoria’s needle and syringe programs and where improvements could be made? Quite a lot it turns out.
Given the proven success of pharmacotherapy treatments including opioid substitution therapy (OST), it is welcome news that the committee devoted considerable time to reviewing the state’s medication assisted treatments for opioid dependence. The report calls for a dedicated unit to actively manage opioid substation therapy policy and explore an OST registry where people can seek information on current prescribers and dispensers.
Even more significantly, the committee recommends the Government fund opioid substitution dispensing fees to remove a major barrier to people accessing treatment. This investment can’t come soon enough. Dispensing fees for drugs such as methadone and buprenorphine can cost $1 to $10 a day – a cost that for some people will be much more than accessing pharmaceutical opioids like oxycodone.
The report also suggests expanding access to OST through financial incentives to GPs and pharmacists, enhancing the role of nurse practitioners in prescribing the drugs and exploring models for hospitals providing OST to suitable patients as part of emergency room treatment.
There is plenty of news on the needle and syringe program front too.
The report calls for a review of the state’s NSP programs to consider increasing availability where there are shortfalls (including after hours) and enhancing the capacity of the workforce to educate people who inject drugs about treatment and referral options.
The report also recommends that Victoria follow the lead of the Australian Capital Territory and remove the prohibition on peer distribution.
In terms of prisons, the report suggests offering screening for prisoners on release and exploring the feasibility of compulsory screening upon entering and exiting prisons. It also recommends monitoring such screening data and international practice to consider whether we should have NSPs in the state’s prisons.
Naloxone features heavily in the report, with the committee calling for more effective distribution of the drug through NSPs and other community health services. The committee also wants naloxone to be more widely available in settings such as crisis and emergency accommodation and ensure it is in the hands of first responders to overdose calls in areas with high rates of injecting heroin use. The committee also recommends providing naloxone to prisoners with a history of opioid use on their release, a model that has worked successfully overseas in countries like Canada.
When it comes to helping people who inject drugs, minimising the harm of intravenous drug use and the role of NSPs this report is based on sound expert opinion. If even some of these recommendations are acted on it would make Victoria the most progressive state or territory in Australia on alcohol and other drug policy. The ball is now in the court of the Government. It has until late September 2018 to officially respond to the report, so watch this space.
– John Ronan