4.1
A recommendation raised by submitters and witnesses from the alcohol and other drugs (AOD) treatment sector was to divert funds that would be used in a public awareness campaign into funding more AOD addiction treatment and other harm minimisation services. The key argument for this recommendation was that efforts to reduce drug demand, and its related harms, should be focused towards the addiction treatment of current drug users:
To state the obvious, demand for illicit drugs comes from people who use drugs, not from people who don't. Treatment programs which allow people who use drugs to not use drugs anymore or to reduce the amount of drugs that they use are probably the best way to reduce the total amount of drug consumption.
4.2
The Department of Health noted that 'harm minimisation rests on the assumption that we cannot stop all people from using illicit substances. However, while people continue to use drugs, some will continue to experience harm'.
4.3
The Police Federation of Australia told the committee they have ongoing concerns with the negative outcomes of some harm minimisation strategies that take the above view, in particular pill-testing, as it is 'leading people down that path of taking pills and giving them the perception that it's safe'.
4.4
This view accords with some research and writing on the ethics of drug‑related harm minimisation programs, which argues that these services enable society to continue to cause 'harm to individuals without accepting responsibility for or acknowledging the social, legal and economic source of those harms'. In other words, harm-minimisation programs such as needle exchange are themselves causing harms by supporting people in continued illicit drug-use, albeit in a less dangerous manner:
[B]y ameliorating their [drugs] worst effects, harm reduction simply relieves the institutions of prohibition and abstinence-based treatment of responsibility for those harms.
4.5
A key concern of some submitters, however, is the current shortfall in the availability of addiction treatment for people seeking to address their illicit drug use, with estimates that there are between 200 000 to 500 000 people who need, want and cannot gain access to AOD treatment each year. The committee was told to beware a demand reduction media campaign that persuades people to seek treatment for drug use if there are not enough treatment places to meet current demand, let alone an increased demand.
4.6
However, the engagement of regular drug users in drug treatment is very low. Only three per cent of users of stimulant drugs such as ecstasy, methamphetamine and cocaine reported that they were currently receiving drug treatment. Where people do engage, 21 per cent of treatments are ended by the client against advice. The relapse rate after treatment is around 50 per cent, similar to other chronic health conditions such as asthma, high blood pressure and diabetes.
4.7
Additionally, recent reporting indicates serious concerns with the addiction treatments provided from some rehabilitation centres that are requirements of bail or parole conditions, with clients reporting some do not include formal drug and alcohol rehabilitation programs.
4.8
Currently, publicly funded health services are required to meet health accreditation standards, but registration and accreditation for privately operated AOD treatment providers is optional, with many such organisations operating with no external oversight or control. This is set to change.
4.9
Prior to the Council of Australian Governments (COAG) being disbanded, the Ministerial Drug and Alcohol Forum (MDAF) endorsed the National Quality Framework for Drug and Alcohol Treatment Services (AOD framework), which will set a nationally consistent quality benchmark that consumers can expect from treatment providers and will impose registration and accreditation requirements applicable to all AOD providers, regardless of whether or not they receive government funding. These requirements come into effect from 29 November 2022 onwards.
4.10
However, the above changes do not appear to improve outcome reporting on the efficacy of treatment, which will remain hard to quantify. There is no standard approach taken to evaluating longitudinal outcomes of drug addiction treatment, with no reporting requirements at all for privately funded addiction treatment services. Additionally, as outlined in chapter one, the MDAF has been disbanded and there does not appear to be a replacement formal mechanism where law enforcement agencies are able to have input to health departments' oversight or regulation of illicit drug addiction treatment policies, services and approaches.
4.11
This lack of law enforcement oversight is of concern in relation to AOD treatment services linked to drug-diversion programs that annually see up to 41 000 people who have committed lower-order crimes diverted from the criminal justice system into AOD treatment.
4.12
The Police Federation of Australia raised concerns with the performance outcomes of these drug rehabilitation services, and recommended further research into the regulation and oversight of police and court-ordered AOD treatment programs and their impact on recidivism rates.
Committee view
4.13
It is clear that the AOD treatment sector believes that the best way to reduce illicit drug use is to address current drug users through addiction treatment. It is understandable that they have come to this view, taking into account their extensive experience working at the sharp end of illicit drug use, where they daily see the impacts of drug use on individuals and their family members.
4.14
Reasonably, AOD organisations focus on the harms felt by their client base, generally being higher volume drug users who correspondingly experience higher volume harms. However, drug-related harms are also felt by people who use a lower volume of illicit drugs for recreational use, albeit harms that are harder to measure as they are often restricted to the reduced educational, professional and economic outcomes for individuals. Additionally, there are broader harms caused to society by the manufacture and distribution of drugs, as well as the harms caused where people may engage in criminal conduct to support the costs of drug use.
4.15
Illicit drug policy should not just look at how to reduce current rates of illicit drug use by stopping people who are already using them, it should also seek to reduce rates into the future by preventing or delaying people from starting illicit drug use.
4.16
The committee is deeply concerned that the disbanding of the Ministerial Forum on Drugs, a Council of Australian Governments body, does not appear to have been replaced with any formal mechanism through which health and law enforcement agencies can cooperate and share knowledge related to reducing illicit drug demand. The committee is concerned that this will have the effect of reducing law enforcement perspectives on policies to address this important issue. While there are significant health implications for individual users of illicit drugs, there are even more significant law enforcement implications for the broader community regarding the overall illicit drug trade.
4.17
The committee is deeply concerned that in the laudable approach to reduce harms felt by regular drug users, the harms felt by the broader community in relation to drug-related crimes are being ignored or understated. While the problem of illicit drug use must include a health approach, policy and practice appears to have tipped the balance too far in ignoring the necessity for law enforcement approaches to remain a valuable part of the picture.
4.18
The committee recommends the Australian Government establish a formal mechanism to ensure that Commonwealth, State and Territory law enforcement bodies have a strong, equal voice in developing policies and strategies to reduce illicit drug demand, including drug treatment services.
4.19
The committee recommends the Australian Government support research, potentially by the Australian Institute of Criminology, into the efficacy of addiction treatment programs in reducing drug-related crime recidivism.