Looking Forward...

The AODCCC holds the following views and will continue to advocate for these points.

Evidence-based strategies.

While there may be clear evidence-based strategies available, there are often limitations to accessing these due to opposing ideological positions within Governments and the community at large. Harm Reduction strategies are a good example of this. For instance, it is known that Drug Testing Programs and Safe Injecting Facilities can and do reduce harms and save lives (1, 2), and we know that Cannabis Law Reform can provide alternative solutions and could shift the focus of illicit drug use to a health challenge, rather than a justice issue (3). There are many examples of evidence not being acted upon.

The AODCCC advocates for more emphasis to be placed on evidence-based strategies. We need to draw on and utilize the expertise and progress made in other parts of Australia and the world, and have the courage to move forward on these options. We acknowledge that collaboration and consensus is key to achieving this, and we respect that communities hold a variety of views, but let’s always give time to look to the evidence, have the difficult conversations and be courageous to act accordingly.

Broad consultation and engagement within communities.

Engaging those with a direct lived and living experience of alcohol and other drug use is an opportunity to not only inform real solutions gained through experience, but also provide individuals and their families with a sense of empowerment when seeking to address these complex issues. Through engagement, we can foster respect and instill a sense of purpose and human connection, all while working towards a collective goal.

Lived Experience representation in the workforce.

The AODCCC promotes and advocates for the following points in relation to lived experience representation in the workforce:

  1.  Participation of alcohol and other drug workers, service users and consumers (including family members), in all sector and systems planning and relevant policy development.
  2.  The use of non-stigmatising and qualified terminology in policy, planning and resource development, that is identified by participants as the most relevant and appropriate. Such as, alcohol and other drug “consumers”, “family members”, “service users”, “peers”, “people with lived experience”, or “people with relevant personal experience”. 
  3.  Recognition that it is a person’s choice whether they self-identify as to their relevant personal experience with alcohol and other drugs. This includes:
    ▪ How they are represented as systems advocates.
    ▪ Having the ability to negotiate their job-titles when employed as a “Peer”.
  4.  Prioritising the personal safety of workers and systems advocates who identify as having relevant personal alcohol and other drug experience. We are supportive of effective initiatives that contribute to personal and professional development, which enhances their safety and the safety of service users. We recognise the value that people with alcohol and other drug relevant personal experience have brought and continue to bring, to the alcohol and other drug sector workforce, and their capacity to balance lived and learnt experience.
  5.  Promoting options and choices for service users to engage with staff members with relevant personal experience.
  6.  Promoting strategies that enable career pathways for people with relevant personal experience into sector employment.

What does the research say?

Justice issue – health issue:
Treating drug use as a justice issue disproportionately impacts vulnerable and marginalised groups in society. Imprisonment leads to isolation and can result in an increased risk of overdose once released from prison facilities (4).

Whilst we still have a way to go with this, the Western Australian justice system is beginning to recognise drug use as a significant health issue, with the implementation of rehabilitation programs and therapeutic communities into the prison system. In the 2021-22 Department of Justice Annual Report, the following were achieved:
▪ The Solid Steps program run at the Mallee Alcohol and Other Drug Rehabilitation Unit at Casuarina Prison, saw 75 adult men successfully completing the program, of whom 50 were then released from prison and only 4 have returned to custody under new offences.
▪ The Wandoo Rehabilitation Prison saw 50 adult women successfully complete the alcohol and other drug rehabilitation program, of whom 30 were then released from custody and none have reoffended.
▪ A new culturally integrated, alcohol and other drug rehabilitation unit is set to open in Bunbury Regional Prison from mid to late 2023 (5).

Drug checking and safe injecting services in the community:
Currently in Australia there are only two safe injecting facilities (SIFs); the Uniting Medically Supervised Injecting Centre in Sydney and the North Richmond Community Health Medically Supervised Injecting Room in Melbourne. Ongoing evaluation of these facilities suggest they need to be seen as essential health services, due to the significant harm reduction response they provide and without SIFs, there is an increased risk of unsafe/ unsupervised injecting drug use and increased risk of overdose within the community (1). Along with this, there is evidence to suggest that the safe environment and education on injecting drugs and overdose management that these facilities provide, can reduce the demand for ambulance services for this cohort in Australian communities. Therefore, freeing up health services and first responders for other health emergencies in the community (6).

SIFs have historically been accused of emphasising the uptake of drug use and drug trafficking. However, global evidence found across Canada and Australia, suggest that SIFs implemented in areas of high rates of injecting drug use, fulfil their purpose of ensuring safer use, reducing the risk of overdose and improving access to care, all without enhancing drug use in the community or increasing crime or drug trafficking occurrences (7, 8).
Such facilities should co-exist with other harm reduction initiatives such as drug checking/ pill testing services.

CanTEST is the first drug checking clinic to be introduced to the Australian community. The Canberra based service provides free and confidential pill testing along with optional support from health professionals and peer educators. In its first few months of operation, the service has been well received by service users (people who use drugs) and is producing new information about the Australian drug market, which is in turn informing public health alerts and keeping the community safer (9).

The interim report highlights the effectiveness of the CanTEST pilot so far, and is supportive of the need to further implement drug checking into the community on a more permanent basis, with emphasis on the need for these services around festivals and large events where drugs are expected to be present (9). The pilot has been extended to August 2023.

Lived Experience expertise and Peer-based models:
Research from Canada suggests that SIFs in particular, work best when they are peer-led and run under a peer-based model (10). The same can be said for Australian based alcohol and other drug services and interventions. The inclusion of lived experience expertise and peer-based models, can effectively bridge a gap between organisations and services, and the people accessing these platforms (11). Lived experience expertise within a service or organisation, has the ability to create a level of understanding and empathy otherwise unachievable, and fosters greater equality and efforts to reduce power imbalances between consumer and provider (11).

A portion of AODCCC members who completed our Peer Workforce Consumer Survey (124 participants) have provided an example of this. The WANADA and AODCCC Peer Workforce and Consumer Survey Report shows that 94% of consumers emphasised the benefits of service providers employing workers with a relevant personal experience, identifying that these workers represent a sense of hope and increased comfort, the ability to build rapport with consumers, and increased confidence in the support they provide, leading to better outcomes (12).

1) Roxburgh, A., Jauncey, M., Day, C. et al. Adapting harm reduction services during COVID-19: lessons from the supervised injecting facilities in Australia. Harm Reduct J 18, 20 (2021). https://doi.org/10.1186/s12954-021-00471-x

2) Supervised Injecting Facilities. Alcohol and Drug Foundation. (2021). Available at: https://adf.org.au/reducing-risk/supervised-injecting-facilities/

3) Decriminalisation in Detail. Alcohol and Drug Foundation. (2021). Available at: https://adf.org.au/talking-about-drugs/law/decriminalisation/decriminalisation-detail/

4) Binswanger, I.A., Stern, M.F., Deyo, R.A., Heagerty, P.J., Cheadle, A., Elmore, J.G. and Koepsell, T.D. (2007). Release from Prison — A High Risk of Death for Former Inmates. New England Journal of Medicine, [online] 356(2), pp.157–165. doi: https://www.nejm.org/doi/full/10.1056/NEJMsa064115

5) Annual Report 2021-22. (2022). Western Australia: Department of Justice. Available at: https://www.wa.gov.au/government/publications/department-of-justice-annual-reports

6) Salmon AM, van Beek I, Amin J, Kaldor J, Maher L. The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia. Addiction. 2010 Apr;105(4):676-83. doi: 10.1111/j.1360-0443.2009.02837.x Available at: https://pubmed.ncbi.nlm.nih.gov/20148794/

7) Potier, C., Laprévote, V., Dubois-Arber, F., Cottencin, O. and Rolland, B. (2014). Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence, 145(1), pp.48–68. doi: https://doi.org/10.1016/j.drugalcdep.2014.10.012

8) Levengood TW, Yoon GH, Davoust MJ, Ogden SN, Marshall BDL, Cahill SR, Bazzi AR. Supervised Injection Facilities as Harm Reduction: A Systematic Review. Am J Prev Med. 2021 Nov;61(5):738-749. doi: 10.1016/j.amepre.2021.04.017. Available at: https://pubmed.ncbi.nlm.nih.gov/34218964/

9) Olsen A, Baillie G, Bruno R, McDonald D, Hammoud M, Peacock A (2022). CanTEST Health and Drug Checking Service Program Evaluation: Interim Report. Australian National University: Canberra, ACT. Available at: https://www.cahma.org.au/wp-content/uploads/2023/01/CanTEST-Interim-Report-Dec-22.pdf

10) Kerr, T., Mitra, S., Kennedy, M.C. et al. Supervised injection facilities in Canada: past, present, and future. Harm Reduct J 14, 28 (2017). https://doi.org/10.1186/s12954-017-0154-1

11) Lived Experience (Peer) Workforces Framework. (2022). [online] Western Australia: Government of Western Australia Mental Health Commission. Available at: https://livedexperienceworkforces.com.au/

12) WANADA, AODCCC (2022). Western Australian Alcohol and Other Drug Sector Peer Workforce and Consumer Survey. Available at: https://aodccc.org/wp-content/uploads/2022/11/WANADA-and-AODCCC-%E2%80%93-Peer-workforce-and-consumer-survey-%E2%80%93-Report.pdf

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