6. Harm Minimisation and the National Drug Strategy Flashcards
what is drug related harm?
directly or indirectly affects the health, safety, security, social functioning and productivity of all Australians.
what is direct drug related harm?
illness and diseases, accident and injury
what is indirect harm (in general)?
Things like if we feel safe when we walk down the street, it is a sense of danger or things that can affect other people in the community
what do drug related harms cause or contribute to?
illness and disease, accident and injury violence and crime, family and social disruption, economic costs and workplace concerns.
what do illicit drug related harms include?
… in addition to drug-related harms, more likely to be prosecution and conviction, (impact of criminal conviction in somebody’s life) and involvement in production and distribution of illicit drugs.
what did the APS say in 2008 about drug-related harm?
Not all substance use is harmful, but the use of any psychoactive substance has the potential to cause harm, and the likelihood of harm occurring increases with greater level of use.
what are the misconceptions of drug related harm?
- The ‘addictive nature’ / dependence of a substance causes them to be harmful
- Harm most associated with illicit drugs
- Harms primarily affect the individual user
what drugs are most likely to lead to dependence?
nicotine and herioin
what does dependence require?
repetitive use (single use does not case addiction)
what is often mistaken and does not contribute, on their own to harm?
the chemical nature and addictive qualities of the drug
what does drug use ofen lead to?
leads to dependence and serious problems in a minority of cases
what are harms most associated with illicit drugs?
economic costs
what did Collins & Lapsley, 2008 discover with regards to illicit drug use between 2004-2005?
they looked at social costs related to substance use and found that most was spent on tobacco and alcohol
what are tangible harms?
things you can see (e.g. drink driving)
what are intangible harms?
things you cant see (e.g. quality of life)
what is most money spent on with illicit drugs>
crime
what is most money spent on with tobacco
production in the home
for every heavy/ frequent drinker, how many others are negatively affected?
four (Rumbold & Hamilton, 1998)
how do drug users impact overrall society/
they contribute to and reinforce social disadvantages
how do drug users impact on families?
neglect, violence, separation, financial and legal problems
what are children more likely to develop with parents who have drug problems?
behavioural and emotional problems, poorer school performance and victims of child maltreatment
how is work performance affected by drug use?
absenteeism, loss of productivity, work accidents
what percentage of crime is related to substance use?
70%
what are hte potential areas of harm?
acquisition, administration, context, relationship with other/societal relationships, intoxication or regular use and dependence
what is acquisition of drugs and how is it a harm?
how people get the drugs which include hanging out with certain peer groups, purchasing phony drugs online and risky contact with dealers
how is administration a risk of harm?
injection - Hepatitis C other STDs,
what is the safest way to administer a drug
by eating
what is involved in the contexts that could be an area of harm?
the environement, this ties in with relationships. e.g. celebration vs stress relief
what is an example of how relationships with others and in society a harm?
getting drug tested at work and losing job
what are the three factors in Thorley’s model of drug related harm?
dependence, regular use, intoxication
what are problems relating to dependence in Thorley’s model?
discomfort when refraining from use, inability to rest, phobias, isolation, withdrawal, anxiety, social problems, homeless, loss of control
what does Thorley mean by regular use
continued use over a longer period of tome
what are problems relating to regular use in Thorley’s model?
medical and health problems, child neglect, withdrawal, family problems, relationship problems, financial problems
what are problems relating to intoxication in Thorley’s model?
accidents, aggression/violence, marital disputes, suicides, drink driving, drowning, legal problems
Who developed the notion of Harm Minimisation and why?
Bob Hawke when he was prime minister because his family was heavily influenced by his daughter’s heroine addiction/
when was the Harm Minimisation notion developed?
1985
what did Brown et al say in the 1986 report regarding the Harm Minimization notion
Workshop report: ‘While there are still the traditional polarised views on the use of drugs, there is now increasingly a common ground within the Australian community on appropriate action on the abuse of drugs’
what was The Harm Minimisation workshop formally called?
Drugs in Australia: National action Workshop
what did the Howard government do in 1998 with Harm Minimisation
he made the landmark decision to embark on its “Tough on Drugs” policy and to override a Ministerial Council on Drug Strategy decision to support a trial of the use of prescribed heroine
when did the policy of Harm Minimisation end?
it never did, it is still ongoing in both state and federal policy
what is them mission for the National Drug Strategy
To build safe and healthy communities by minimising alcohol, tobacco and other drug-related health, social and economic harms among individuals, families and communities
how is the harm minimisation approach and the National Drug Strategy implemented?
with national commitment to the approach, in the implementation of harm minimisation, jurisdictions will have programs, initiatives and priorities reflecting local circumstances and areas of responsibility
what are the priorities (1) of the national drug strategy?
o Community engagement and involvement in identifying and responding to issues.
o Improve national coordination for identifying and addressing drug use and its harms, sharing jurisdictional information on innovative approaches, and developing effective responses.
o Develop and share data and research that support evidence informed approaches.
what is the policy of harm minimisation?
policy and programs which prioritise the aim of decreasing the negative effects of drug use
what does the policy of harm minimisation include?
a range of options aiming to improve health, social and economic outcomes for individuals and communities
what is harm reduction policy?
strategies, interventions & policies by which the principles of harm minimisation are impemented
what is the premise of the harm minimisation policy?
that drug use brings a particular balance of harms and benefits to individuals and the community. Knowledge of the risks of behaviour does not automatically lead to changes in behaviour
what does the harm minimisation policy accept?
that drugs use has always existed and will continue to exist, completely eradicating drug use is impossible, continued focus on eradicating drug problems may result in more harm for society
what are the objectives of the harm minimisation policy?
identification of harmful consequences for individuals, those around them and the community, implement strategies to reduce this harm, focuses primarily on reducing harm, not use
what are the three aspects of the harm minimisation policy?
demand reduction, supply reduction and harm reduction
what is involved in the demand reduction aspect of the harm minimisation policy
prevent uptake and delay, first use, reduce harmful use, support people to recover
what is involved in the supply reduction aspect of harm minimisation?
control ilicit drug and precursor availability, reduce illicit drug availability and accessibility
what is involved in the harm reduction aspect of the the harm minimisation policy
reduce risk behaviours and provide safe settings
what are the strategic principles of the the harm minimisation policy?
partnerships, coordination and collaboration, evidence-informed responses, national direction, jurisdictional implementation
what is the main goal in the demand reduction aspect of the harm minimisation policy?
… to prevent the uptake and/or delay the onset of use of alcohol, tobacco and other drugs; reduce the misuse of alcohol and the use of tobacco and other drugs in the community; and support people to recover from dependence and reintegrate with the community
what are the National drug strategy priorities (2)/
Develop new and innovative responses to prevent uptake, delay the first use and reduce harmful levels of alcohol, tobacco and other drug use, including
what are ways that the National drug strategy can develop new and innovative responses to prevent uptake, delay first use and reduce harmful levels of substance use?
o Building community knowledge of alcohol, tobacco and other drug-related harms to encourage cessation and reduce harmful use
o Increasing access to treatment services, including new approaches responding to emerging issues
o Facilitating treatment service planning and responsibility for implementation between levels of government
o Exploring effective price mechanisms shown to reduce uptake and use
o Reducing exposure to licit drugs, particularly for young people and adolescents, through regulation of promotion and marketing.
what are the goals of the supply reduction aspect of the harm minimisation policy?
to prevent, stop, disrupt or otherwise reduce the production and supply of illegal drug, & control, manage and/or regulate the availability of legal drugs
what is the aim of the supply reduction aspect of the harm minimisation policy?
to reduce the supply of particular drugs within society, or restrict access of particular drugs to certain people. - if the drug is not available then the community will not be troubled by its use
what is the national drug strategy policy (3)?
develop responses that restrict or regulate the availability of alcohol, tobacco and other drugs
how will the NDS develop responses and restrict or regulate the availability of drugs?
o Identifying and responding to challenges arising from new supply modes through the internet, postal services and other emerging technologies
o Working with those at the point of supply for licit drugs, chemicals and equipment to minimise their misuse and opportunities for diversion to unlawful use
o Identifying and responding to new methods for illicit drug production and supply
o Supporting nationally consistent legislative and regulatory responses, particularly for international border control and challenges inhibiting inter-jurisdictional collaboration
o Enhancing use and sharing of intelligence to identify and respond to emerging trends and issues.
what is the goal of the harm reduction aspect of the harm minimisation policy>
to reduce the adverse health, social and economic consequences of the use of alcohol, tobacco and other drugs
who does the what harm reduction aspect of the harm minimisation policy aim to protect?
community safety and amenity, families, individuals
what are some more examples of harm minimisation in AOD work practice?
- Encourage abstinence and consumption reduction (moderation)
- Provide accurate and factual information about AOD – impacts, risks, consequences
- Information about safety issues – drug, method, context
- IVDU – not sharing, safe disposal, non-injecting routes of administration
- Risk behaviours – safer sex, not driving
- Resuscitation in case of overdose in their presence
- Regular health checks
- General lifestyle factors – sleep, diet, balance of activities
- Crisis service contacts (e.g. 24 hours)
- Engagement and therapeutic relationship
what is the national drug strategy priority (4)?
enhancing harm reduction approaches
how will the NDS enhance harm reduction approaches?
o Providing opportunities for intervention amongst high prevalence or high risk groups, including the implementation of settings based approaches to modify risk behaviours
o Monitoring emerging drug issues to provide advice to the health, law enforcement, education and social services sectors for informing individuals and the community regarding risky behaviours
o Continuing evidence based strategies shown to reduce blood borne virus, decrease road trauma, reduce passive smoking exposure, and decrease overdose risk,
o Enhancing systems to facilitate greater diversion into health interventions from the criminal justice system, particularly for Aboriginal and Torres Strait Islander peoples, or other at risk populations who may be experiencing disproportionate harm
o Increasing access to pharmacotherapy demonstrated to reduce drug dependence, and encourage treatment engagement and compliance
what are the sub-strategies of the NDS?
- National Aboriginal and Torres Strait Islander Peoples Drug Strategy
- National Alcohol Strategy
- National Tobacco Strategy
- National Illicit Drugs Strategy
- National Pharmaceutical Drug Misuse Strategy
- National Workforce Development Strategy
- National Drug Research and Data Strategy.
who are the popular populations of interest of the NDS?
- Aboriginal and Torres Strait Islander People
- People with mental illness
- Young people
- Older people
- People in contact with the cirminal justice system
- Culturally and Linguistically diverse populations
- People identifying as gay, lesbian, bisexual, transgender or intersex
what are the measures of success of the NDS?
- Average age of uptake of drugs, by drug type
- Recent use of any drug, people living in households
- Arrestees’ illicit drug use in the month before committing an offence for which charged
- Victims of drug related incidents
- Drug related burden of disease, including mortality
what are the outcomes of the NDS?
- Fewer Australians are smoking / exposed to second-hand smoke
- Fewer people using illegal drugs
- Law enforcement
- Heroin shortage sustained, with use remaining at low levels
- Opal fuel has contributed to a 70% reduction in petrol sniffing (regional/remote)
- Established early intervention and diversion programs
- Drink driving strategies
- More is known about brief interventions, detoxification, pharmacological and psychosocial treatment approaches
what shows that fewer Australians are smoking / exposed to second hand smoking?
daily smoking decreased and bans on advertising, bans on smoking in enclosed public spaces and significant investments in public education and media campaigns
what indicates that fewer people are using illegal drugs?
o recent use fell from 22% (1998) to 13.4% (2010)
o Cannabis fell from 17.9 % (1998) to 9.1% (2010)
what indicates enhanced law enforcement of drugs?
o illegal drug seizures increased by 70% between 1999–2000 and 2008–09;
o collective weight of seizures increased by about116%
what are the criticisms of the NDS?
- Harms continue to happen
- Change of presenting problem / Increased poly-drug use
- Query funding focused on anti-drug education
- Lack of innovation e.g. prescribed heroin trials
- No influence on HCV transmission
- Over allocation of additional resources to Federal Police, National Crime Authority and Customs
what did the over allocation of additional resources to the federal police, national crime authority and customs lead to?
little long term impact on prevalence of use, and even less impact on the harms associated with the use (APS, 2008). Eg increase in Oceania cocaine use, from 1.4–1.7% in 2009 to 1.5–1.9% in 2010 (reflected rise in Australia) with use remaining stable in Europe.
what did Lang, in 2004, discover about the NDS?
o Temporary ST decrease in use
o Negated impact: supply sources find other destinations; new supply routes; drug substitution
o Little reduction in usage overall & other harms introduced (increased criminality & less emphasis on health harms)
what are the statistics related to drug trafficking that impacts the effectiveness of the NDS?
o 10-15% heroin & 30% cocaine is intercepted worldwide
o At least 70% needs to be intercepted to have an impact
o Continues to increase due to expanding market and poverty; $400 billion (US) trade; 300% profits
(UN, 2008)
what was the gross cost of the harm reduction initiatives?
$243 million
how many syringes were provided in harm reduction intiatives
27-31 million
what is the net financial savings as a result of harm reduction initiatives?
$1.03 billion that is $1 spent saves $4
what is the net financial savings including the productivity gain/costs?
$5.85 billion that is $1 saves $27
what were the savings that resulted from the National Evaluation of Pharmocotherapies for Opioid Dependence?
Each $1 invested in methadone saves $4-$5 reduced health care costs and crime. Thus halved levels of property crime, dealing and violent cromes
What did the National Treatment Outcomes Research Study find a reduction in?
there was a reduction in IVDU, acquisition crime, drug selling, improved psychological health
what indicates reduced risks thanks to the National Treatment Outcomes Research Study?
deaths x 4
heroin overdose x 5
needle sharing x 5
HIV x 3
what are the challenges in the NDS?
- Risky drinking, drinking to intoxication and alcohol-related disease, injury and violence
- Smoking rates are unacceptably & particularly among Aboriginal and Torres Strait Islander people
- Changing trends & patterns of use of, & harms from, illegal drugs
- Increasing harms from cannabis.
- Expansion of cocaine
- Rates of heroin and other injecting drug use have stabilised at low levels, harms persist
- ‘analogue’ drugs – internet sales; many have not yet been captured under the drug law schedules which govern their legal status.
- Polydrug use
- Pharmaceutical misuse
what indicated that risky drinking, drinking to intoxication and alcohol-related disease, injury and violence was a challenge in the NDS?
o estimated 813 072 Australians (15+) hospitalised for alcohol-attributable injury and disease from 1995-2005
o leading cause of Australian road deaths,
what indicated that rates are unacceptably & particularly among Aboriginal and Torres Strait Islander people was a challenge in the NDS?
o The Council of Australian Governments (COAG) & National Healthcare Agreement goal of reducing prevalence to 10% & halving rate in ATSI people
o Rates also high in other sub-groups
what indicated that increasing harms of cannabis was a challenge in the NDS?
o Increase in hospital presentations for cannabis related issues for older people / nearly doubled among users aged 30–39.
o Hospital presentations for cannabis-induced psychosis were highest among users aged 20–29.
o Outpatient treatment episodes for cannabis related problems increased by 30%
o Cannabis cultivation continues to be an activity of interest for organised crime.
what areas of drug use arent studied too well?
steroid and other performance drugs, and smoking rates
why is it so difficult to reduce harm caused by smoking?
because tobacco doesnt fit the normal strategies, and thus the strategies do not work
What is the combined drug response budget from the Commonwealth and State governments?
o 55% is spent on law enforcement (supply reduction)
o 23% spent on prevention (demand reduction)
o 17% on treatment (demand reduction)
o 5% on harm reduction
what is the success of the Global Commission’s War on Drugs?
it failed
in the Australia21 report, what did treating drugs as criminal acts cause?
it has driven their production and consumption underground and built a criminal industry
in the Australia21 report, what does defining personal use as a criminal acts avoid?
responsibility to regulate and control the quality of substances that are in widespread ares
what are the benefits of reducing harm rather than reducing use?
o recognises abstinence as one of many strategies
o acknowledges that abstinence is insufficient on its own
o other strategies are needed as a more realistic alternative to abstinence or as a step toward future abstinence
o different strategies will suit different people at different times, and that a wide range of strategies is required
how is harm minimisation the opposite to law enforcement?
o demand reduction and supply control strategies are an integral part of the overall approach
o Law enforcement can adopt harm reduction:
o Support other harm reduction strategies (e.g. needle and syringe programs)
o Improve links between police & treatment services
o Cautioning & diversion schemes
o Changing legal status of drug or policing attitudes & behaviour (e.g. cannabis)
